Individual
KELLIE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
835 MASON ST STE B220, DEARBORN, MI 48124-2262
(313) 561-9064
Mailing address
835 MASON ST STE B220, DEARBORN, MI 48124-2262
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301016322
MI
Other
Enumeration date
05/16/2018
Last updated
06/28/2023
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