Individual
MRS. STEPHANIE L COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1600 22ND AVE FL 3, MERIDIAN, MS 39301-3223
(601) 703-8370
Mailing address
PO BOX 749215, ATLANTA, GA 30374-9215
(901) 226-3186
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
46755
MS
103TB0200X
Cognitive & Behavioral Psychologist
614
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02885
BCBS
NE
05
—
47063717826
—
NE
Enumeration date
11/23/2005
Last updated
09/24/2024
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