Healthcare Provider Details

I. General information

NPI: 1033657549
Provider Name (Legal Business Name): COOPER LEE GROGER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 PERKINS RD STE 180B
BATON ROUGE LA
70808-9111
US

IV. Provider business mailing address

7520 PERKINS RD STE 180B
BATON ROUGE LA
70808-9111
US

V. Phone/Fax

Practice location:
  • Phone: 225-276-8428
  • Fax:
Mailing address:
  • Phone: 225-276-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7196
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: