MEDICARE: COOPER PSYCHIATRIC CARE PLUS, PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1801757760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPER PSYCHIATRIC CARE PLUS, PLLC

Provider Business Mailing Address
First Line	:	7042 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-4510
Country	:	US
Telephone Number	:	773-241-9874
Fax Number	:	877-317-4429

Provider Business Practice Location Address
First Line	:	4922 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3142
Country	:	US
Telephone Number	:	773-241-9874
Fax Number	:	877-317-4429

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER COOPER
Credential	:	PMHNP-BC
Telephone Number	:	773-241-9874

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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