Michael Cooper, MA, LPC

Individual provider Active NPI Professional Counselor · Shelby Township, MI

NPI 1508528340 · NPPES record last updated Jun 21, 2023

Key facts

NPI
1508528340
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
6401223209 (MI)
Practice address
1947 Jonathan Cir
Shelby Township, MI 48317-3821
Phone
(248) 931-8411
NPI assigned
Oct 8, 2021
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
6401223209MIMDProfessional Counselor
6451018945MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Professional Counseling, P.C. Past
since Oct 1, 2021
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6451018945 MI
Professional Counselor 101YP2500X 6401223209 MI Yes

Addresses

Primary practice location

1947 Jonathan Cir
Shelby Township, MI 48317-3821

Mailing address

1947 Jonathan Cir
Shelby Township, MI 48317-3821
Phone (248) 931-8411

Other providers in Shelby Township, MI

All providers in Shelby Township, MI · Professional Counselor in Michigan

Sources for this page

Verify at the official NPI Registry.