Healthcare Provider Details

I. General information

NPI: 1053789875
Provider Name (Legal Business Name): SUNNYE ELIZABETH COPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNNYE ELIZABETH LOAR

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 1ST ST
ALTUS AFB OK
73523-5004
US

IV. Provider business mailing address

301 N 1ST ST
ALTUS AFB OK
73523-5004
US

V. Phone/Fax

Practice location:
  • Phone: 580-481-5376
  • Fax:
Mailing address:
  • Phone: 580-481-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4648
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: