Provider Demographics
NPI:1134532195
Name:COOPER, HEATHER (LICSW, CMHS)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LICSW, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 SANDIFUR PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6738
Mailing Address - Country:US
Mailing Address - Phone:509-491-0991
Mailing Address - Fax:
Practice Address - Street 1:9825 SANDIFUR PKWY STE D
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6738
Practice Address - Country:US
Practice Address - Phone:509-491-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000097071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical