Healthcare Provider Details

I. General information

NPI: 1679677843
Provider Name (Legal Business Name): CAROL A. LOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90TH N.31ST
CLINTON OK
73601
US

IV. Provider business mailing address

120 CARPENTER LN
ELK CITY OK
73644-1604
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-6021
  • Fax: 580-323-5635
Mailing address:
  • Phone: 580-225-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: