Healthcare Provider Details

I. General information

NPI: 1154848653
Provider Name (Legal Business Name): HEATHER COOPER THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N PLAZA BLVD
CHILLICOTHEE OH
45601-1787
US

IV. Provider business mailing address

PO BOX 55
WALTON KY
41094-0055
US

V. Phone/Fax

Practice location:
  • Phone: 740-270-3286
  • Fax: 740-773-3985
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: