Provider Demographics
NPI:1750368254
Name:COPPINGER, MARY P (MS LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:COPPINGER
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:COPPINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LMFT
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE 1155
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-297-2448
Mailing Address - Fax:877-570-9832
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE 1155
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-297-2448
Practice Address - Fax:877-570-9832
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist