Provider Demographics
NPI:1154502631
Name:JENNIFER R. COOPER, PHD, PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:JENNIFER R. COOPER, PHD, PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-207-3937
Mailing Address - Street 1:833 NW BUCHANAN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6217
Mailing Address - Country:US
Mailing Address - Phone:541-207-3937
Mailing Address - Fax:541-207-3623
Practice Address - Street 1:833 NW BUCHANAN AVE STE 10
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6217
Practice Address - Country:US
Practice Address - Phone:541-207-3937
Practice Address - Fax:541-207-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1835103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty