Provider Demographics
NPI:1205434511
Name:COOPER COUNSELING, PLLC
Entity type:Organization
Organization Name:COOPER COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CREED
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MA ED, LCMHC, NCC
Authorized Official - Phone:336-970-7301
Mailing Address - Street 1:224 WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-7549
Mailing Address - Country:US
Mailing Address - Phone:336-970-7301
Mailing Address - Fax:
Practice Address - Street 1:224 WOODBRIDGE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-7549
Practice Address - Country:US
Practice Address - Phone:336-970-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164932919Medicaid