Provider Demographics
NPI:1316744071
Name:COOPER, JACQUELINE SUZANNE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:COOPER
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 COUNTY ROAD 1608
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-3631
Mailing Address - Country:US
Mailing Address - Phone:936-645-3559
Mailing Address - Fax:
Practice Address - Street 1:622 COUNTY ROAD 1608
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-3631
Practice Address - Country:US
Practice Address - Phone:936-645-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional