Healthcare Provider Details

I. General information

NPI: 1851080014
Provider Name (Legal Business Name): DYLAN COOPER AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 10/23/2026
Certification Date: 10/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 HAVEN AVE STE 110
RANCHO CUCAMONGA CA
91730-5429
US

IV. Provider business mailing address

6800 INDIANA AVE STE 260
RIVERSIDE CA
92506-4287
US

V. Phone/Fax

Practice location:
  • Phone: 909-757-5770
  • Fax:
Mailing address:
  • Phone: 951-782-0040
  • Fax: 951-782-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: