Provider Demographics
NPI:1255652624
Name:COOPER, GLORIA ANNETTE (MED/LPC)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ANNETTE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MED/LPC
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:ANNETTER
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDLPC
Mailing Address - Street 1:5435 SUNBURY DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-1941
Mailing Address - Country:US
Mailing Address - Phone:409-225-5292
Mailing Address - Fax:
Practice Address - Street 1:2750 S 8TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-7719
Practice Address - Country:US
Practice Address - Phone:409-839-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64406101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health