Provider Demographics
NPI:1528399243
Name:COOPER, KERI ANN (LPC)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:ANN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12741 RESEARCH BLVD STE 505
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4329
Mailing Address - Country:US
Mailing Address - Phone:512-632-0053
Mailing Address - Fax:
Practice Address - Street 1:12741 RESEARCH BLVD STE 505
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4329
Practice Address - Country:US
Practice Address - Phone:512-632-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208528401Medicaid