Provider Demographics
NPI:1942242227
Name:WOODY COOPER, JAMECA (PHD)
Entity Type:Individual
Prefix:
First Name:JAMECA
Middle Name:
Last Name:WOODY COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 BONHOMME AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3515
Mailing Address - Country:US
Mailing Address - Phone:314-502-9256
Mailing Address - Fax:314-293-6813
Practice Address - Street 1:8000 BONHOMME AVE STE 206
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3515
Practice Address - Country:US
Practice Address - Phone:314-502-9256
Practice Address - Fax:314-293-6813
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical