Provider Demographics
NPI:1932690955
Name:COOPER, LISA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10812 CARDINAL CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-7968
Mailing Address - Country:US
Mailing Address - Phone:317-449-9418
Mailing Address - Fax:574-800-4114
Practice Address - Street 1:10812 CARDINAL CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-7968
Practice Address - Country:US
Practice Address - Phone:317-449-9418
Practice Address - Fax:574-800-4114
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool