Provider Demographics
NPI:1518659465
Name:MCCLUNG, COOPER LOWE I (LPC)
Entity Type:Individual
Prefix:MR
First Name:COOPER
Middle Name:LOWE
Last Name:MCCLUNG
Suffix:I
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 BOAT CLUB RD STE 160
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3631
Mailing Address - Country:US
Mailing Address - Phone:940-210-9540
Mailing Address - Fax:
Practice Address - Street 1:8101 BOAT CLUB RD STE 160
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3631
Practice Address - Country:US
Practice Address - Phone:940-210-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health