Provider Demographics
NPI:1609034024
Name:COOPER, JENNIFER A (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HEATHER LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6216
Mailing Address - Country:US
Mailing Address - Phone:979-297-4335
Mailing Address - Fax:979-297-4315
Practice Address - Street 1:110 HEATHER LN
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6216
Practice Address - Country:US
Practice Address - Phone:979-297-4335
Practice Address - Fax:979-297-4315
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37872104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker