Healthcare Provider Details

I. General information

NPI: 1902320252
Provider Name (Legal Business Name): ELAINE COOPER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NE 13TH ST
OKLAHOMA CITY OK
73117-1099
US

IV. Provider business mailing address

PO BOX 12978
OKLAHOMA CITY OK
73157-2978
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5700
  • Fax:
Mailing address:
  • Phone: 405-858-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: