Provider Demographics
NPI:1457910143
Name:COOPER, ALEXANDRIA YOUNG (IMFT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:YOUNG
Last Name:COOPER
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17200 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-9183
Mailing Address - Country:US
Mailing Address - Phone:614-282-2823
Mailing Address - Fax:
Practice Address - Street 1:312 3RD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5618
Practice Address - Country:US
Practice Address - Phone:440-323-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM0900009106H00000X
OHF.2100159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0352797Medicaid