Healthcare Provider Details

I. General information

NPI: 1679923874
Provider Name (Legal Business Name): ASHLEY COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 COBBLESTONE DR
NORTH BRANCH MI
48461-8887
US

IV. Provider business mailing address

5885 COBBLESTONE DR
NORTH BRANCH MI
48461-8887
US

V. Phone/Fax

Practice location:
  • Phone: 989-621-4603
  • Fax:
Mailing address:
  • Phone: 989-621-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: