Individual
MICALA COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 E SHAWNEE CIR, TAHLEQUAH, OK 74464-2528
(918) 772-4004
Mailing address
1510 SHAWNEE CIRCLE, TAHLEQUAH, OK 74464
(918) 772-4004
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6707-P
OK
Other
Enumeration date
04/08/2019
Last updated
04/08/2019
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