Healthcare Provider Details

I. General information

NPI: 1972003994
Provider Name (Legal Business Name): TYLER WILLIAMSON COPELAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S WALNUT ST
STILLWATER OK
74074
US

IV. Provider business mailing address

604 S WALNUT ST
STILLWATER OK
74074-4222
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-2202
  • Fax: 405-445-3780
Mailing address:
  • Phone: 405-372-2202
  • Fax: 405-445-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: