Provider Demographics
NPI:1639345135
Name:COPLEY, TERESA C (MA MS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:C
Last Name:COPLEY
Suffix:
Gender:F
Credentials:MA MS
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:C
Other - Last Name:SAMSOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6349 US 60 E STE 4A
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-733-7642
Mailing Address - Fax:304-733-7642
Practice Address - Street 1:6349 US ROUTE 60 E
Practice Address - Street 2:STE 4
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1248
Practice Address - Country:US
Practice Address - Phone:304-733-7642
Practice Address - Fax:304-721-8889
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV967103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011546Medicaid