Provider Demographics
NPI:1417176256
Name:COPLEN, WALTER BUFORD (MA,LPC,NCC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:BUFORD
Last Name:COPLEN
Suffix:
Gender:M
Credentials:MA,LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501A W ASH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4609
Mailing Address - Country:US
Mailing Address - Phone:573-446-9665
Mailing Address - Fax:573-446-9757
Practice Address - Street 1:2501A W ASH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4609
Practice Address - Country:US
Practice Address - Phone:573-446-9665
Practice Address - Fax:573-446-9757
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional