Shaun Cooper, PH.D

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

6301008358 Issued in MI

Practice address

12501 Hamilton
Highland Park, MI 48203

Phone

(313) 587-3092

NPI assigned

Apr 21, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• The Guidance Center

  • Community/Behavioral Health Agency
  • Southgate, MI
  • NPI 1609947027
  Medicare reassignment NPD (past)
• Rainbow Center of Michigan Inc

  • Specialty Pharmacy
  • Monroe, MI
  • NPI 1952597544
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1609167907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 725098",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480725098",
            "telephone_number": "313-587-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 HAMILTON",
            "city": "HIGHLAND PARK",
            "state": "MI",
            "postal_code": "48203",
            "telephone_number": "313-587-3092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "SHAUN",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-21",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6301008358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2604097",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ida Veronica Colquitt, LLP
• William Colston
• Community Veterans Services Inc
• Maureen Connolly, M.D.
• Paula Cook, LPN
• Shavonne Craigead
• Seantane Jamiah Curtis
• D&H Gardner Serives LLC
• Marina Shama Dahdolan
• Carina S Daniel

• Addiction (Substance Use Disorder) Psychologist in Highland Park, MI
• Providers in Highland Park, MI by specialty
• Addiction (Substance Use Disorder) Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.