MEDICARE: MISS TRACY A COOPER LPC

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
1	101YP2500X	Professional Counselor	6401006343	MI

General Provider Information

NPI Number	:	1417998550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TRACY A COOPER LPC

Provider Business Mailing Address
First Line	:	125 E SOUTHERN AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5041
Country	:	US
Telephone Number	:	231-726-3582
Fax Number	:	231-722-6933

Provider Business Practice Location Address
First Line	:	125 E SOUTHERN AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5041
Country	:	US
Telephone Number	:	231-726-3582
Fax Number	:	231-722-6933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	05/16/2012

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Directions to “ MISS TRACY A COOPER LPC” Practice Location

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