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NPI Code Detail

MEDICARE: MELISSA COOPER LCSW

MEDICARE: MELISSA COOPER LCSW
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
11041C0700XClinical Social WorkerC7752MS

General Provider Information

NPI Number : 1639365422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA COOPER LCSW
Provider Business Mailing Address
First Line : 302 N JACKSON ST
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-2504
Country : US
Telephone Number : 626-327-7916
Fax Number :
Provider Business Practice Location Address
First Line : 1011 MAIN ST
Second Line :
City : COLUMBUS
State : MS
Zip : 39701-4751
Country : US
Telephone Number : 662-327-7916
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2007
Last Update Date : 09/18/2020

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Directions to “ MELISSA COOPER LCSW” Practice Location

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