Healthcare Provider Details

I. General information

NPI: 1205442001
Provider Name (Legal Business Name): MATTHEW PAUL COOPER LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 E GRAND RIVER AVE
HOWELL MI
48843-8503
US

IV. Provider business mailing address

282 TAFT ST
YPSILANTI MI
48197-4727
US

V. Phone/Fax

Practice location:
  • Phone: 517-546-4126
  • Fax: 517-546-1300
Mailing address:
  • Phone: 734-389-3645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801107347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: