MEDICARE: MRS. JORDAN COOPER LPC

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
1	101YM0800X	Mental Health Counselor	LPC05169	AL

General Provider Information

NPI Number	:	1700500931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JORDAN COOPER LPC

Provider Business Mailing Address
First Line	:	521 WOODS COVE RD
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-4930
Country	:	US
Telephone Number	:	256-223-7270
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 WOODS COVE RD
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-4930
Country	:	US
Telephone Number	:	256-223-7270
Fax Number	:	256-223-7271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/04/2025

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