Provider Demographics
NPI:1225626559
Name:COOPER, ELIZABETH MICHELLE (MFT, LMFT-ASSOCIATE)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MFT, LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 E POLK RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47138-8863
Mailing Address - Country:US
Mailing Address - Phone:812-413-2468
Mailing Address - Fax:812-889-8499
Practice Address - Street 1:5135 E POLK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:IN
Practice Address - Zip Code:47138-8863
Practice Address - Country:US
Practice Address - Phone:812-413-2468
Practice Address - Fax:812-889-8499
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99102188A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist