Provider Demographics
NPI:1285951889
Name:COOPER, THOMAS ALAN (MBA, MS, LMHC, CAP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:COOPER
Suffix:
Gender:M
Credentials:MBA, MS, LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 49TH AVE N
Mailing Address - Street 2:STE S-102
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3563
Mailing Address - Country:US
Mailing Address - Phone:727-644-3563
Mailing Address - Fax:
Practice Address - Street 1:5800 49TH AVE N
Practice Address - Street 2:STE S-102
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-3563
Practice Address - Country:US
Practice Address - Phone:727-644-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4452101YA0400X
FLMH 11062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)