Provider Demographics
NPI:1790546976
Name:COOPER, JOSHUA NICHOLUS (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:NICHOLUS
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10908
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-0908
Mailing Address - Country:US
Mailing Address - Phone:936-569-4232
Mailing Address - Fax:
Practice Address - Street 1:2490 BOONVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-2327
Practice Address - Country:US
Practice Address - Phone:979-703-1808
Practice Address - Fax:979-485-9898
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional