Provider Demographics
NPI:1376577486
Name:COOPER, JASON E (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 TROUSDALE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4585
Mailing Address - Country:US
Mailing Address - Phone:615-781-3000
Mailing Address - Fax:850-781-8262
Practice Address - Street 1:4555 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4585
Practice Address - Country:US
Practice Address - Phone:615-781-3000
Practice Address - Fax:850-781-8262
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE609103T00000X
FLPY8028103T00000X, 103TC0700X
TN3403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCX018YMedicare UPIN