MEDICARE: MISS ELAINE COOPER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		OK

General Provider Information

NPI Number	:	1902320252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELAINE COOPER LPC

Provider Business Mailing Address
First Line	:	PO BOX 12978
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73157-2978
Country	:	US
Telephone Number	:	405-858-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NE 13TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1099
Country	:	US
Telephone Number	:	405-271-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	05/09/2019

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