Healthcare Provider Details

I. General information

NPI: 1750263943
Provider Name (Legal Business Name): LAURA COOPER SUDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3784 W VALLEY VIEW DR
CEDAR HILLS UT
84062-8085
US

IV. Provider business mailing address

9449 N CANYON RD
CEDAR HILLS UT
84062-8997
US

V. Phone/Fax

Practice location:
  • Phone: 801-407-9998
  • Fax:
Mailing address:
  • Phone: 801-900-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14188492-6006
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: