Provider Demographics
NPI:1659403558
Name:COOPER, DEBRA L (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 W HARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6037
Mailing Address - Country:US
Mailing Address - Phone:847-347-3033
Mailing Address - Fax:773-628-7624
Practice Address - Street 1:4226 W HARRINGTON LN
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6037
Practice Address - Country:US
Practice Address - Phone:847-347-3033
Practice Address - Fax:773-628-7624
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5971101YA0400X
IL180001195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional