MEDICARE: MRS. STEPHANIE ANN COOPER MFT INTERN

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	106H00000X	Marriage & Family Therapist		UT

General Provider Information

NPI Number	:	1699626895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE ANN COOPER MFT INTERN

Provider Business Mailing Address
First Line	:	462 E GARFIELD AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2214
Country	:	US
Telephone Number	:	801-706-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 S 500 E STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2085
Country	:	US
Telephone Number	:	801-842-6234
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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