Healthcare Provider Details

I. General information

NPI: 1891618054
Provider Name (Legal Business Name): REGGIE COOPER/SALLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E INDEPENDENCE ST
TULSA OK
74106-5407
US

IV. Provider business mailing address

1515 E INDEPENDENCE ST
TULSA OK
74106-5407
US

V. Phone/Fax

Practice location:
  • Phone: 539-525-1371
  • Fax:
Mailing address:
  • Phone: 539-525-1371
  • 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: