Provider Demographics
NPI:1194120048
Name:KOEPP, NORA
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:KOEPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 S 440
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-4571
Mailing Address - Country:US
Mailing Address - Phone:918-645-9525
Mailing Address - Fax:
Practice Address - Street 1:11110 S 440
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:OK
Practice Address - Zip Code:74352-4571
Practice Address - Country:US
Practice Address - Phone:918-645-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health