Provider Demographics
NPI:1740598952
Name:COOPER, GREGORY (MSW)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1138
Mailing Address - Country:US
Mailing Address - Phone:616-451-2021
Mailing Address - Fax:616-451-8936
Practice Address - Street 1:805 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1138
Practice Address - Country:US
Practice Address - Phone:616-451-2021
Practice Address - Fax:616-451-8936
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010672171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical