Healthcare Provider Details

I. General information

NPI: 1174450811
Provider Name (Legal Business Name): KASIE COOPER THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 RICHARD DR
HARRISON MI
48625-9289
US

IV. Provider business mailing address

741 RICHARD DR
HARRISON MI
48625-9289
US

V. Phone/Fax

Practice location:
  • Phone: 989-429-7341
  • Fax:
Mailing address:
  • Phone: 989-429-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KASIE COOPER
Title or Position: THERAPIST
Credential: LMSW
Phone: 989-402-4446