Provider Demographics
NPI:1154673002
Name:COOPER, SARAH (LMSW, CCTP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 W SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6992
Mailing Address - Country:US
Mailing Address - Phone:317-750-3336
Mailing Address - Fax:
Practice Address - Street 1:2102 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1935
Practice Address - Country:US
Practice Address - Phone:602-526-8315
Practice Address - Fax:623-205-6516
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-16429104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker