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1134615305
STACEY COOPER
BOISE, ID
NPI
1134615305
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: ID LCSW-42921)
Enumeration Date
2018-07-10
Last Update Date
2023-07-19
Business Address
STACEY COOPER LCSW
3606 W MOORE ST
BOISE, ID 83703-5725
Phone number: 208-779-1582
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Mailing Address
STACEY COOPER LCSW
977 SW 3RD ST
ONTARIO, OR 97914-3536
Phone number: 208-779-1582
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