Provider Demographics
NPI:1376249656
Name:COOPER, LAUREN (LMHCA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WATERFALL DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-3668
Mailing Address - Country:US
Mailing Address - Phone:574-404-8790
Mailing Address - Fax:
Practice Address - Street 1:240 WATERFALL DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-3668
Practice Address - Country:US
Practice Address - Phone:574-404-8790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000986A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health