Provider Demographics
NPI:1295393387
Name:COOPER COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:COOPER COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:918-605-9202
Mailing Address - Street 1:10310 N 138TH EAST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4641
Mailing Address - Country:US
Mailing Address - Phone:405-254-6081
Mailing Address - Fax:
Practice Address - Street 1:10310 N 138TH EAST AVE STE 201
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4641
Practice Address - Country:US
Practice Address - Phone:405-254-6081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200474420Medicaid