MEDICARE: MS. DEBRA L COOPER LCPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	5971	IL
2	101YP2500X	Professional Counselor	180001195	IL

General Provider Information

NPI Number	:	1659403558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA L COOPER LCPC

Provider Business Mailing Address
First Line	:	4226 W HARRINGTON LN
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6037
Country	:	US
Telephone Number	:	847-347-3033
Fax Number	:	773-628-7624

Provider Business Practice Location Address
First Line	:	4226 W HARRINGTON LN
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6037
Country	:	US
Telephone Number	:	847-347-3033
Fax Number	:	773-628-7624

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	09/11/2025

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