Healthcare Provider Details

I. General information

NPI: 1669616447
Provider Name (Legal Business Name): DONALD T COOPER M.A., LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10514 OBERRENDER RD
NEEDVILLE TX
77461-5700
US

IV. Provider business mailing address

2495 S MASON RD APT. 634
KATY TX
77450-6068
US

V. Phone/Fax

Practice location:
  • Phone: 281-904-7798
  • Fax:
Mailing address:
  • Phone: 304-918-1294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65017
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005030
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: