MEDICARE: DONTAE JAMAHL COOPER LPC-A

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
1	101YP2500X	Professional Counselor		OK

General Provider Information

NPI Number	:	1740122779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONTAE JAMAHL COOPER LPC-A

Provider Business Mailing Address
First Line	:	12212 BRINLEY REIGN DR
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-8952
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 E STATE HIGHWAY 152
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-5116
Country	:	US
Telephone Number	:	405-329-1157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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