Provider Demographics
NPI:1013287614
Name:COONAN, MICHAEL FRANKLIN (LMSW ACSW BCD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANKLIN
Last Name:COONAN
Suffix:
Gender:M
Credentials:LMSW ACSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8221
Mailing Address - Country:US
Mailing Address - Phone:850-377-1960
Mailing Address - Fax:
Practice Address - Street 1:1889 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8221
Practice Address - Country:US
Practice Address - Phone:850-377-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010661291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical