Provider Demographics
NPI:1942811310
Name:COOPER, KESHIA MARANDA SANDERS (PHD)
Entity type:Individual
Prefix:
First Name:KESHIA
Middle Name:MARANDA SANDERS
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KESHIA
Other - Middle Name:MARANDA
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:751 HEBRON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5055
Mailing Address - Country:US
Mailing Address - Phone:469-549-4200
Mailing Address - Fax:469-549-4201
Practice Address - Street 1:751 HEBRON PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5054
Practice Address - Country:US
Practice Address - Phone:469-549-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent