Healthcare Provider Details

I. General information

NPI: 1902653280
Provider Name (Legal Business Name): ANEITA COOPER, PHD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 WEST COURT STREET
PARAGOULD AR
72450-5921
US

IV. Provider business mailing address

4752 HIGHWAY 49 S
PARAGOULD AR
72450-8808
US

V. Phone/Fax

Practice location:
  • Phone: 870-450-1514
  • Fax: 855-933-0240
Mailing address:
  • Phone: 870-450-1514
  • Fax: 855-933-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANEITA COOPER
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: PHD, LPC
Phone: 870-450-1514