Healthcare Provider Details

I. General information

NPI: 1689508210
Provider Name (Legal Business Name): NICOLE COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 CENTRAL PARK W STE 106
TOLEDO OH
43617-3009
US

IV. Provider business mailing address

3231 CENTRAL PARK W STE 106
TOLEDO OH
43617-3009
US

V. Phone/Fax

Practice location:
  • Phone: 844-316-7599
  • Fax:
Mailing address:
  • Phone: 844-316-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDCAPRE.195467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: