Provider Demographics
NPI:1265017297
Name:COOPER, KHADJAH BRIELLE (LPC)
Entity type:Individual
Prefix:
First Name:KHADJAH
Middle Name:BRIELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KHADIJAH
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:401 WINDRUSH DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5869
Mailing Address - Country:US
Mailing Address - Phone:985-602-7312
Mailing Address - Fax:
Practice Address - Street 1:401 WINDRUSH DR APT 3
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5869
Practice Address - Country:US
Practice Address - Phone:985-602-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9739101YM0800X, 101YP2500X
LA010754062171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator