Provider Demographics
NPI:1669616447
Name:COOPER, DONALD T (MA, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:T
Last Name:COOPER
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 S MASON RD
Mailing Address - Street 2:APT. 634
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6068
Mailing Address - Country:US
Mailing Address - Phone:304-918-1294
Mailing Address - Fax:
Practice Address - Street 1:10514 OBERRENDER RD
Practice Address - Street 2:
Practice Address - City:NEEDVILLE
Practice Address - State:TX
Practice Address - Zip Code:77461-5700
Practice Address - Country:US
Practice Address - Phone:281-904-7798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65017101YP2500X
PAPC005030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional