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General NPI Number Information
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NPI Number | 1952197683
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Entity Type | Individual
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Provider Name | MRS. ULUNDA SHANAE COOPER
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Gender | Female
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 6120 SW PARK AVE
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City | LAWTON
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State | OK
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Zip | 73505-7719
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Country | US
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Telephone | 580-647-6194
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Fax |
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Provider Business Mailing Address
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Address Line | 714 SW 45TH ST
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City | LAWTON
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State | OK
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Zip | 73505-7803
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Country | US
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Telephone | 580-595-4808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1821508763
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License Number State | OK
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