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General NPI Number Information
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NPI Number | 1063099471
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Entity Type | Individual
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Provider Name | MALLORY CUTRER COOPER M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 4500 I 55 N STE 279
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City | JACKSON
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State | MS
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Zip | 39211-5981
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Country | US
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Telephone | 601-397-5673
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CHANNING CIR
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City | CANTON
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State | MS
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Zip | 39046-5509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3020
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License Number State | MS
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