Provider Demographics
NPI:1477898120
Name:PSYCHOLOGICAL REHABILITATION & CONSULTING, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL REHABILITATION & CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-633-2832
Mailing Address - Street 1:4204 W KENT ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8754
Mailing Address - Country:US
Mailing Address - Phone:918-633-2832
Mailing Address - Fax:
Practice Address - Street 1:4204 W KENT ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8754
Practice Address - Country:US
Practice Address - Phone:918-633-2832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK802251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health