Provider Demographics
NPI:1720846686
Name:COOPER, ASHLEY MICHELLE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WARD ST
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:TX
Mailing Address - Zip Code:75567-4427
Mailing Address - Country:US
Mailing Address - Phone:903-314-0916
Mailing Address - Fax:214-972-0643
Practice Address - Street 1:6500 SUMMERHILL RD STE 2B
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1728
Practice Address - Country:US
Practice Address - Phone:800-972-0643
Practice Address - Fax:214-279-5032
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health