Provider Demographics
NPI:1033513452
Name:COOPER, JILLISSA CHRISTINE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JILLISSA
Middle Name:CHRISTINE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:JILLISSA
Other - Middle Name:
Other - Last Name:CHEREPON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2001 W PLANO PKWY STE 1400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8607
Mailing Address - Country:US
Mailing Address - Phone:972-212-9175
Mailing Address - Fax:
Practice Address - Street 1:2001 W PLANO PKWY STE 1400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8607
Practice Address - Country:US
Practice Address - Phone:469-440-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional