Provider Demographics
NPI:1134610900
Name:COOPER, MARIA C (LCPC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:C
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1905
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-1905
Mailing Address - Country:US
Mailing Address - Phone:620-275-0644
Mailing Address - Fax:
Practice Address - Street 1:506 AVENUE L
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-5319
Practice Address - Country:US
Practice Address - Phone:620-227-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201110030AMedicaid