Individual
TIA NICOLE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSC, MHA
Contact information
Practice address
12424 SUMMERHOUSE DR APT 24, SAINT LOUIS, MO 63146-2924
(314) 283-6614
Mailing address
12424 SUMMERHOUSE DR APT 24, SAINT LOUIS, MO 63146-2924
(314) 283-6614
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
MO
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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