Provider Demographics
NPI:1528416039
Name:COOPER, KRYSTAL (MA, LPC, LMHC, LPCMH)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA, LPC, LMHC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-0612
Mailing Address - Country:US
Mailing Address - Phone:848-338-3651
Mailing Address - Fax:
Practice Address - Street 1:270 EAST LN
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2802
Practice Address - Country:US
Practice Address - Phone:877-505-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123288101YM0800X
DEPC-0011498101YM0800X
ALLPC05245101YP2500X
NJ37PC00740800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health