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NPI Code Detail

MEDICARE: KRYSTAL COOPER MA, LPC, LMHC, LPCMH

MEDICARE: KRYSTAL COOPER MA, LPC, LMHC, LPCMH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor123288IA
2101YM0800XMental Health CounselorPC-0011498DE
3101YP2500XProfessional CounselorLPC05245AL
4101YP2500XProfessional Counselor37PC00740800NJ

General Provider Information

NPI Number : 1528416039
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL COOPER MA, LPC, LMHC, LPCMH
Provider Business Mailing Address
First Line : PO BOX 612
Second Line :
City : OLD BRIDGE
State : NJ
Zip : 08857-0612
Country : US
Telephone Number : 848-338-3651
Fax Number :
Provider Business Practice Location Address
First Line : 270 EAST LN
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-2802
Country : US
Telephone Number : 877-505-7147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2016
Last Update Date : 05/22/2025

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