Provider Demographics
NPI:1871252825
Name:KELLY COOPER COUNSELING PLLC
Entity Type:Organization
Organization Name:KELLY COOPER COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:830-734-4000
Mailing Address - Street 1:591 WILDROSE CIR
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9178
Mailing Address - Country:US
Mailing Address - Phone:830-734-4000
Mailing Address - Fax:
Practice Address - Street 1:591 WILDROSE CIR
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9178
Practice Address - Country:US
Practice Address - Phone:830-734-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)