Provider Demographics
NPI:1568005130
Name:COOPER, DEREK KEVIN (LMHC, LCPC)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:KEVIN
Last Name:COOPER
Suffix:
Gender:M
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15631 ASH WAY APT D509
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5361
Mailing Address - Country:US
Mailing Address - Phone:240-761-8838
Mailing Address - Fax:
Practice Address - Street 1:21727 76TH AVE W STE C
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7549
Practice Address - Country:US
Practice Address - Phone:206-677-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61159709101YM0800X
MDLC11328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health