Provider Demographics
NPI:1720483852
Name:DR J W COOPER, PLLC
Entity Type:Organization
Organization Name:DR J W COOPER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-837-6782
Mailing Address - Street 1:500 N CENTRAL EXPY
Mailing Address - Street 2:STE 260
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6772
Mailing Address - Country:US
Mailing Address - Phone:972-837-6782
Mailing Address - Fax:
Practice Address - Street 1:500 N CENTRAL EXPY
Practice Address - Street 2:STE 260
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6772
Practice Address - Country:US
Practice Address - Phone:972-837-6782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty