Provider Demographics
NPI:1033859756
Name:COY, MARY JANE (PHD, LMSW, CCTS-I/F)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:COY
Suffix:
Gender:F
Credentials:PHD, LMSW, CCTS-I/F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E AMARO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-4604
Mailing Address - Country:US
Mailing Address - Phone:520-201-1071
Mailing Address - Fax:
Practice Address - Street 1:140 W SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7686
Practice Address - Country:US
Practice Address - Phone:520-623-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-162781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical