Provider Demographics
NPI:1174721997
Name:COOPER, MICHAEL PAUL-DAVID (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL-DAVID
Last Name:COOPER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 E JOLLY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6818
Mailing Address - Country:US
Mailing Address - Phone:517-346-8306
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:201 W RAILROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1547
Practice Address - Country:US
Practice Address - Phone:989-224-5300
Practice Address - Fax:517-346-8291
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010881921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical