Healthcare Provider Details

I. General information

NPI: 1689040057
Provider Name (Legal Business Name): ANDREA COOPER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 NORTHWOODS BLVD STE C
COLUMBUS OH
43235-4727
US

IV. Provider business mailing address

134 NORTHWOODS BLVD STE C
COLUMBUS OH
43235-4727
US

V. Phone/Fax

Practice location:
  • Phone: 380-257-6680
  • Fax: 614-699-8428
Mailing address:
  • Phone: 380-257-6680
  • Fax: 614-699-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08353
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: