MEDICARE: STACEY COOPER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-42921	ID
2	1041C0700X	Clinical Social Worker	L14940	OR

General Provider Information

NPI Number	:	1134615305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY COOPER LCSW

Provider Business Mailing Address
First Line	:	97 N 29TH ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-3669
Country	:	US
Telephone Number	:	208-603-4930
Fax Number	:	208-205-8062

Provider Business Practice Location Address
First Line	:	97 N 29TH ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-3669
Country	:	US
Telephone Number	:	208-603-4930
Fax Number	:	208-205-8062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	02/13/2026

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Directions to “ STACEY COOPER LCSW” Practice Location

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