Provider Demographics
NPI:1083908693
Name:COOPER, THERESE (LPC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NE 100TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-3345
Mailing Address - Country:US
Mailing Address - Phone:405-821-7767
Mailing Address - Fax:405-378-2212
Practice Address - Street 1:3700 N CLASSEN BLVD STE C35
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2836
Practice Address - Country:US
Practice Address - Phone:405-821-7767
Practice Address - Fax:405-378-2212
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200338270BMedicaid