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General NPI Number Information
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NPI Number | 1033752894
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Entity Type | Individual
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Provider Name | BETHANY LANAE' COOPER PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 9 N EDWIN C MOSES BLVD
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City | DAYTON
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State | OH
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Zip | 45402-8470
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Country | US
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Telephone | 937-775-4300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 933421
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City | CLEVELAND
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State | OH
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Zip | 44193-0039
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Country | US
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Telephone | 937-641-5072
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Fax | 937-641-6129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | P.08782
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | P.08782
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License Number State | OH
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