Provider Demographics
NPI:1952793754
Name:COOPER, JASON WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
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 1:500 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:214-790-3125
Mailing Address - Fax:972-516-1162
Practice Address - Street 1:500 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:214-790-3125
Practice Address - Fax:972-516-1162
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36836OtherTEXAS STATE PSYCHOLOGY LICENSE