Provider Demographics
NPI:1659637098
Name:COOPER, RANDLE L JR
Entity Type:Individual
Prefix:
First Name:RANDLE
Middle Name:L
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15425 CORAL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-9771
Mailing Address - Country:US
Mailing Address - Phone:405-436-5557
Mailing Address - Fax:
Practice Address - Street 1:15425 CORAL CREEK LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-9771
Practice Address - Country:US
Practice Address - Phone:405-436-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst