Healthcare Provider Details

I. General information

NPI: 1083024178
Provider Name (Legal Business Name): LISA COOPER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 LINDA LN
DEL CITY OK
73115-5012
US

IV. Provider business mailing address

1621 WOODCREEK CT
NORMAN OK
73071-1995
US

V. Phone/Fax

Practice location:
  • Phone: 405-733-5437
  • Fax:
Mailing address:
  • Phone: 208-340-1203
  • Fax: 405-732-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6655
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: