Individual
MRS. DALLAS MICHELLE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW, PSRS
Contact information
Practice address
RR 1, BOX 35D, BOLEY, OK 74829
(918) 667-3367
Mailing address
P. O. BOX 218, BOLEY, OK 74829
(918) 667-3367
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100685660A
—
OK
05
—
100685660D
—
OK
Enumeration date
03/11/2009
Last updated
03/11/2009
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