Provider Demographics
NPI:1053022897
Name:COOPER, LLEWELLYN (MS ALC, NCC)
Entity type:Individual
Prefix:
First Name:LLEWELLYN
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:MS ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 RITCHEY RDLOUDON TN 37774
Mailing Address - Street 2:UNIT B
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774
Mailing Address - Country:US
Mailing Address - Phone:205-527-0730
Mailing Address - Fax:
Practice Address - Street 1:1000 GREEN RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-7062
Practice Address - Country:US
Practice Address - Phone:423-442-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL04299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health