Provider Demographics
NPI:1568591014
Name:COKER, MARY JANE (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:COKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-8913
Mailing Address - Country:US
Mailing Address - Phone:660-747-2335
Mailing Address - Fax:
Practice Address - Street 1:123 E GAY ST
Practice Address - Street 2:SUITE S-4
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1809
Practice Address - Country:US
Practice Address - Phone:660-747-9242
Practice Address - Fax:660-747-4465
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002027410101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional