Provider Demographics
NPI:1265894836
Name:POLAND COOPER, MARSHA NAN
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:NAN
Last Name:POLAND COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAN
Other - Middle Name:
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 DESTINY LANE SUITE 109
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:270-393-9833
Mailing Address - Fax:270-393-9835
Practice Address - Street 1:1011 LEHMAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6515
Practice Address - Country:US
Practice Address - Phone:270-799-5000
Practice Address - Fax:270-393-9835
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional