Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003237892 |
---|---|
Provider Name | Amy Diane Coplen |
First Address | Warsaw, IN 46580-3163 |
Second Address | Warsaw, IN 46580-3163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2013 |
Last Update Date | 20/12/2013 |