Provider Demographics
NPI:1477245843
Name:COOPER, KATHLEEN JEANETTE (MA, LLPC, LLMFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JEANETTE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA, LLPC, LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 EDLING DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1150
Mailing Address - Country:US
Mailing Address - Phone:734-559-3621
Mailing Address - Fax:
Practice Address - Street 1:5340 HOLIDAY TER STE 13
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2181
Practice Address - Country:US
Practice Address - Phone:269-372-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022828101Y00000X
MI4151001091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty