MEDICARE: TWILA STAR 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639749625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TWILA STAR COOPER

Provider Business Mailing Address
First Line	:	1172 W GALBRAITH RD STE 203
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	647 ARLINGTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5426
Country	:	US
Telephone Number	:	513-580-2018
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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Directions to “ TWILA STAR COOPER ” Practice Location

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