Individual
MARY COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
229 W GENTRY AVE, CHECOTAH, OK 74426-2439
(918) 473-1575
Mailing address
313 SE 1ST ST, CHECOTAH, OK 74426-5035
(918) 473-3003
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007745880
—
OK
Enumeration date
09/09/2011
Last updated
12/18/2019
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