Provider Demographics
NPI:1013198399
Name:COOPER, THOMAS W (LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:COOPER
Suffix:
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 1:319 RUNNELS ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2527
Mailing Address - Country:US
Mailing Address - Phone:432-263-0027
Mailing Address - Fax:432-268-9897
Practice Address - Street 1:319 RUNNELS ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2527
Practice Address - Country:US
Practice Address - Phone:432-263-0027
Practice Address - Fax:432-268-9897
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99116101Y00000X
TX16767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor