Healthcare Provider Details

I. General information

NPI: 1679163737
Provider Name (Legal Business Name): CLINT COOPER LMFT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13951 N SCOTTSDALE RD STE 110
SCOTTSDALE AZ
85254-3454
US

IV. Provider business mailing address

20343 N HAYDEN RD STE 105-465
SCOTTSDALE AZ
85255-3876
US

V. Phone/Fax

Practice location:
  • Phone: 623-299-2439
  • Fax:
Mailing address:
  • Phone: 623-299-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLINTON COOPER
Title or Position: OWNER
Credential: LMFT
Phone: 336-963-9885