Individual
SHAUN COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
12501 HAMILTON, HIGHLAND PARK, MI 48203
(313) 587-3092
Mailing address
PO BOX 725098, BERKLEY, MI 48072-5098
(313) 587-3092
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
6301008358
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2604097
—
OH
Enumeration date
04/21/2011
Last updated
04/21/2011
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