Provider Demographics
NPI:1871711523
Name:COOLEY, MICHELLE MAYBERRY (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MAYBERRY
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 W CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-4018
Mailing Address - Country:US
Mailing Address - Phone:480-892-9511
Mailing Address - Fax:
Practice Address - Street 1:235 S EL DORADO CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-1044
Practice Address - Country:US
Practice Address - Phone:480-968-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-114431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical