Individual
CLAYTON E COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 E MAIN ST, TISHOMINGO, OK 73460-2351
(580) 371-3776
(580) 371-2056
Mailing address
200 MICHELLE DR, POTEAU, OK 74953-2083
(918) 839-0377
(918) 647-8121
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226970A
—
OK
Enumeration date
12/03/2012
Last updated
12/03/2012
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