Healthcare Provider Details

I. General information

NPI: 1295646412
Provider Name (Legal Business Name): BRIAN COOPER LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WALNUT BLVD STE 109
ROCHESTER MI
48307-2073
US

IV. Provider business mailing address

71 WALNUT BLVD STE 109
ROCHESTER MI
48307-2073
US

V. Phone/Fax

Practice location:
  • Phone: 248-997-0158
  • Fax:
Mailing address:
  • Phone: 248-997-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401224152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: