Healthcare Provider Details

I. General information

NPI: 1962090985
Provider Name (Legal Business Name): RICHARD COOPER JR. PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43000 W 9 MILE RD STE 301
NOVI MI
48375-4129
US

IV. Provider business mailing address

43000 W 9 MILE RD STE 301
NOVI MI
48375-4129
US

V. Phone/Fax

Practice location:
  • Phone: 734-449-3939
  • Fax:
Mailing address:
  • Phone: 734-245-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704319576
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: