Provider Demographics
NPI:1073722666
Name:KOOS, ERIN AIMEE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:AIMEE
Last Name:KOOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3933
Mailing Address - Country:US
Mailing Address - Phone:405-323-8860
Mailing Address - Fax:
Practice Address - Street 1:800 NE 15TH ST
Practice Address - Street 2:ROB-426
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4614
Practice Address - Country:US
Practice Address - Phone:405-271-2474
Practice Address - Fax:405-271-6236
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical