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NPI Code Detail

MEDICARE: KENDRA MICHELLE COOPER BHP, LAC

MEDICARE: KENDRA MICHELLE COOPER BHP, LAC
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
1101Y00000XCounselorLAC-21062AZ

General Provider Information

NPI Number : 1710798962
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA MICHELLE COOPER BHP, LAC
Provider Business Mailing Address
First Line : 7212 W LEWIS AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85035-1342
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 502 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85009-4420
Country : US
Telephone Number : 602-258-6797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2025
Last Update Date : 01/16/2025

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Directions to “ KENDRA MICHELLE COOPER BHP, LAC” Practice Location

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