Healthcare Provider Details

I. General information

NPI: 1881212603
Provider Name (Legal Business Name): NIESHA COOPER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S BREIEL BLVD
MIDDLETOWN OH
45044-5106
US

IV. Provider business mailing address

PO BOX 396
SPRINGBORO OH
45066-0396
US

V. Phone/Fax

Practice location:
  • Phone: 513-849-8670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.2606120
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2204368
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: