Individual
MRS. BETHANY LANAE' COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
9 N EDWIN C MOSES BLVD, DAYTON, OH 45402-8470
(937) 775-4300
Mailing address
PO BOX 933421, CLEVELAND, OH 44193-0039
(937) 641-5072
(937) 641-6129
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
P.08782
OH
103TM1800X
Intellectual & Developmental Disabilities Psychologist
P.08782
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0138490
—
OH
Enumeration date
10/24/2019
Last updated
04/02/2026
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