Provider Demographics
NPI:1922244961
Name:COOPER, JESSICA LATRICE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LATRICE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LATRICE
Other - Last Name:MORANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24815 LAZY TEE LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1120
Mailing Address - Country:US
Mailing Address - Phone:281-224-5827
Mailing Address - Fax:
Practice Address - Street 1:24815 LAZY TEE LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1120
Practice Address - Country:US
Practice Address - Phone:281-224-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical