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NPI Code Detail

MEDICARE: MRS. BETHANY LANAE' COOPER PSYD

MEDICARE: MRS. BETHANY LANAE' COOPER PSYD
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
1103TC2200XClinical Child & Adolescent PsychologistP.08782OH
2103TM1800XIntellectual & Developmental Disabilities PsychologistP.08782OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033752894
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETHANY LANAE' COOPER PSYD
Provider Business Mailing Address
First Line : PO BOX 933421
Second Line :
City : CLEVELAND
State : OH
Zip : 44193-0039
Country : US
Telephone Number : 937-641-5072
Fax Number : 937-641-6129
Provider Business Practice Location Address
First Line : 9 N EDWIN C MOSES BLVD
Second Line :
City : DAYTON
State : OH
Zip : 45402-8470
Country : US
Telephone Number : 937-775-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2019
Last Update Date : 04/02/2026

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