Provider Demographics
NPI:1215594486
Name:COOPER, TAMMEY LEE (BASW)
Entity Type:Individual
Prefix:MS
First Name:TAMMEY
Middle Name:LEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:BASW
Other - Prefix:MS
Other - First Name:TAMMEY
Other - Middle Name:LEE
Other - Last Name:DEPOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BASW
Mailing Address - Street 1:528 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-9649
Mailing Address - Country:US
Mailing Address - Phone:580-222-9148
Mailing Address - Fax:
Practice Address - Street 1:98 BROADLAWN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1723
Practice Address - Country:US
Practice Address - Phone:580-224-2546
Practice Address - Fax:580-224-2659
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator