MEDICARE: HEATHER NICOLE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1689523052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICOLE COOPER

Provider Business Mailing Address
First Line	:	625 STEELE LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3127
Country	:	US
Telephone Number	:	707-576-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 STEELE LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3127
Country	:	US
Telephone Number	:	707-576-0818
Fax Number	:

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	06/08/2026

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Directions to “ HEATHER NICOLE COOPER ” Practice Location

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