Provider Demographics
NPI:1578800520
Name:COPPER PENNY PSYCHOLOGICAL CENTER, PLLC
Entity Type:Organization
Organization Name:COPPER PENNY PSYCHOLOGICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-809-0350
Mailing Address - Street 1:8637 S 73RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6606
Mailing Address - Country:US
Mailing Address - Phone:918-809-0350
Mailing Address - Fax:918-806-8026
Practice Address - Street 1:8637 S 73RD EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6606
Practice Address - Country:US
Practice Address - Phone:918-809-0350
Practice Address - Fax:918-806-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty