Healthcare Provider Details

I. General information

NPI: 1013198399
Provider Name (Legal Business Name): THOMAS W COOPER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 RUNNELS ST
BIG SPRING TX
79720-2527
US

IV. Provider business mailing address

319 RUNNELS ST
BIG SPRING TX
79720-2527
US

V. Phone/Fax

Practice location:
  • Phone: 432-263-0027
  • Fax: 432-268-9897
Mailing address:
  • Phone: 432-263-0027
  • Fax: 432-268-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number99116
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: