Organization
COOPERATIVE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK JACOBSEN MSW, LCSW (OWNER)
(314) 914-5762
Entity
Organization
Contact information
Practice address
412 S CLAY AVE, LOWER LEVEL, KIRKWOOD, MO 63122-5860
(314) 914-5762
Mailing address
412 S CLAY AVE, LOWER LEVEL, KIRKWOOD, MO 63122-5860
(314) 914-5762
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2007031620
MO
Other
Enumeration date
11/03/2016
Last updated
11/03/2016
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