Individual
BRUCE ALAN COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC,AADC, NCACII
Contact information
Practice address
1013 RAMBLER DR, WACO, TX 76710-4049
(956) 204-9630
Mailing address
1013 RAMBLER DR, WACO, TX 76710-4049
(956) 204-9630
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2590
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2590
DSHS
TX
Enumeration date
04/12/2018
Last updated
04/12/2018
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