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Individual
TRACY L COOPER
Active
Individual
TRACY L COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, EI-IMH
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
149.011267
IL
103TM1800X
Intellectual & Developmental Disabilities Psychologist
149.011267
IL
1041C0700X
Clinical Social Worker
Primary
149.011267
IL
2080P0006X
Developmental - Behavioral Pediatrics Physician
149.011267
IL
251S00000X
Community/Behavioral Health Agency
149.011267
IL
Other
Enumeration date
01/19/2006
Last updated
05/11/2023
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