Provider Demographics
NPI:1295253276
Name:COSMA, ALEXANDRIA (LPC)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:COSMA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:COSMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2950 S SERVICE RD APT 4633
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5673
Mailing Address - Country:US
Mailing Address - Phone:405-821-0795
Mailing Address - Fax:
Practice Address - Street 1:317 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1312
Practice Address - Country:US
Practice Address - Phone:405-821-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A1708278101YM0800X
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1295253276Medicaid