Provider Demographics
NPI:1295930329
Name:COOPER, MATTHEW SHAWN JR (MA LPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SHAWN
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:MA LPC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4155
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0155
Mailing Address - Country:US
Mailing Address - Phone:539-664-6602
Mailing Address - Fax:918-364-1904
Practice Address - Street 1:12415 E 191ST ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-6600
Practice Address - Country:US
Practice Address - Phone:539-664-6602
Practice Address - Fax:918-364-1904
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional