Healthcare Provider Details

I. General information

NPI: 1255855110
Provider Name (Legal Business Name): CHRISTOPHER THOMAS COPELAND PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD # WP3445
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD # WP3445
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8001
  • Fax: 405-271-8802
Mailing address:
  • Phone: 405-271-8001
  • Fax: 405-271-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1283
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: