Provider Demographics
NPI:1912219973
Name:POPE, MARSHA W (LMHC)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:W
Last Name:POPE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 S. FLORIDA AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-607-4183
Mailing Address - Fax:863-646-5843
Practice Address - Street 1:5304 S. FLORIDA AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-607-4183
Practice Address - Fax:863-646-5843
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765863000Medicaid