Healthcare Provider Details

I. General information

NPI: 1487535803
Provider Name (Legal Business Name): ERIN COOPER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S STADIUM DR
BROWNSBURG IN
46112-1414
US

IV. Provider business mailing address

310 S STADIUM DR
BROWNSBURG IN
46112-1414
US

V. Phone/Fax

Practice location:
  • Phone: 317-372-7783
  • Fax:
Mailing address:
  • Phone: 317-372-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1599250
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: