Provider Demographics
NPI:1952054785
Name:COOPER, TINA (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CIRCLE AVE APT 6H
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1667
Mailing Address - Country:US
Mailing Address - Phone:708-299-2526
Mailing Address - Fax:
Practice Address - Street 1:101 N WACKER DR FL 17
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-7384
Practice Address - Country:US
Practice Address - Phone:312-898-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0222221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical