Provider Demographics
NPI:1073555405
Name:COPLEN, WOODSON LEE (MED, LMFT,LADC/MH)
Entity Type:Individual
Prefix:
First Name:WOODSON
Middle Name:LEE
Last Name:COPLEN
Suffix:
Gender:M
Credentials:MED, LMFT,LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-1582
Mailing Address - Country:US
Mailing Address - Phone:405-623-9017
Mailing Address - Fax:405-214-0933
Practice Address - Street 1:420 N KICKAPOO AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6643
Practice Address - Country:US
Practice Address - Phone:405-623-9017
Practice Address - Fax:405-214-0933
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK311101YA0400X
OK412101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist