Provider Demographics
NPI:1982035465
Name:COOPER, AMY JEAN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JEAN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1803 WHITES RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2883
Mailing Address - Country:US
Mailing Address - Phone:269-345-5776
Mailing Address - Fax:269-345-4011
Practice Address - Street 1:1803 WHITES RD
Practice Address - Street 2:SUITE 5
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2883
Practice Address - Country:US
Practice Address - Phone:269-345-5776
Practice Address - Fax:269-345-4011
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010957671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical