Healthcare Provider Details

I. General information

NPI: 1831493543
Provider Name (Legal Business Name): DANIEL JOSEPH COOPER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10176 CORPORATE SQUARE DR 100-S
SAINT LOUIS MO
63132-2924
US

IV. Provider business mailing address

10176 CORPORATE SQUARE DR 100-S
SAINT LOUIS MO
63132-2924
US

V. Phone/Fax

Practice location:
  • Phone: 314-896-1572
  • Fax: 314-394-6169
Mailing address:
  • Phone: 314-896-1572
  • Fax: 314-394-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2008032350
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: