Provider Demographics
NPI:1184960379
Name:PRINCE-COOPER, TAMMI LATONYA (LMHC, LCAC, CSAYC)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:LATONYA
Last Name:PRINCE-COOPER
Suffix:
Gender:F
Credentials:LMHC, LCAC, CSAYC
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:L
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, LCAC, CSAYC
Mailing Address - Street 1:11715 FOX RD STE 400-222
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8421
Mailing Address - Country:US
Mailing Address - Phone:317-384-8847
Mailing Address - Fax:
Practice Address - Street 1:11715 FOX RD STE 400-222
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8421
Practice Address - Country:US
Practice Address - Phone:317-384-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000953A101YA0400X
IN39001587A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)