Healthcare Provider Details

I. General information

NPI: 1740122779
Provider Name (Legal Business Name): DONTAE JAMAHL COOPER LPC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17725 FRUITED PLAIN LN
EDMOND OK
73012-8780
US

IV. Provider business mailing address

12212 BRINLEY REIGN DR
YUKON OK
73099-8952
US

V. Phone/Fax

Practice location:
  • Phone: 405-894-0320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: