MEDICARE: COOPER PSYCHIATRIC CARE PLUS LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1437043437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPER PSYCHIATRIC CARE PLUS LLC

Provider Business Mailing Address
First Line	:	332 S. MICHIGAN AVE
Second Line	:	SUITE 121 #5247
City	:	CHICAGO
State	:	IL
Zip	:	60604
Country	:	US
Telephone Number	:	282-995-6161
Fax Number	:	877-317-4429

Provider Business Practice Location Address
First Line	:	7042 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-4510
Country	:	US
Telephone Number	:	281-995-6161
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER NIKKI COOPER
Credential	:	PMHNP
Telephone Number	:	281-995-6161

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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