MEDICARE: JAMECA WOODY COOPER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2006006565	MO

General Provider Information

NPI Number	:	1942242227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMECA WOODY COOPER PHD

Provider Business Mailing Address
First Line	:	8000 BONHOMME AVE STE 206
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-502-9256
Fax Number	:	314-293-6813

Provider Business Practice Location Address
First Line	:	8000 BONHOMME AVE STE 206
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-502-9256
Fax Number	:	314-293-6813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	03/14/2025

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