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NPI Code Detail

MEDICARE: AKENYA COOPER

MEDICARE: AKENYA COOPER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1225177785
Entity Type Code : Individual
Provider Name (Legal Business Name) : AKENYA COOPER
Provider Business Mailing Address
First Line : 2712 S CALHOUN ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number : 260-744-4326
Fax Number : 260-744-0188
Provider Business Practice Location Address
First Line : 2712 S CALHOUN ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number : 260-744-4326
Fax Number : 260-744-0188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/08/2007

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Directions to “ AKENYA COOPER ” Practice Location

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