Provider Demographics
NPI:1750527206
Name:COOPER, AMY (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 2912
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2912
Mailing Address - Country:US
Mailing Address - Phone:907-420-0614
Mailing Address - Fax:907-420-0614
Practice Address - Street 1:44539 STERLING HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7920
Practice Address - Country:US
Practice Address - Phone:907-420-0614
Practice Address - Fax:907-420-0614
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC3232101YP2500X
AK587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0156Medicaid