Individual
KANISHA MICHELLE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 N MARKET ST STE C104, SHREVEPORT, LA 71107-6545
(318) 626-5597
Mailing address
1500 N MARKET ST STE C104, SHREVEPORT, LA 71107-6545
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
05/23/2017
Last updated
06/15/2023
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