Provider Demographics
NPI:1609427145
Name:COOPER, TERRANCE ANN (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:TERRANCE
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41440 BELLRIDGE BLVD APT B115
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1512
Mailing Address - Country:US
Mailing Address - Phone:313-646-5322
Mailing Address - Fax:
Practice Address - Street 1:41440 BELLRIDGE BLVD APT B115
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-1512
Practice Address - Country:US
Practice Address - Phone:313-646-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802090598104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker