MEDICARE: CANDACE COOPER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	245368	KY
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	92347	TX

General Provider Information

NPI Number	:	1528615689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE COOPER LPC

Provider Business Mailing Address
First Line	:	451 BAXTER AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1177
Country	:	US
Telephone Number	:	502-383-2969
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 BAXTER AVE STE 201
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1177
Country	:	US
Telephone Number	:	502-383-2969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	03/13/2026

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Directions to “ CANDACE COOPER LPC” Practice Location

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