Provider Demographics
NPI:1124595871
Name:COOPER, CLINTON (LMFT)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20343 N HAYDEN RD STE 105-465
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3876
Mailing Address - Country:US
Mailing Address - Phone:623-299-2439
Mailing Address - Fax:
Practice Address - Street 1:13951 N SCOTTSDALE RD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3454
Practice Address - Country:US
Practice Address - Phone:623-299-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001648106H00000X
AZLMFT15377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist