Healthcare Provider Details

I. General information

NPI: 1336060300
Provider Name (Legal Business Name): DEFORD CASSELL JAMES COPE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W WHITE RIVER BLVD
MUNCIE IN
47303-3866
US

IV. Provider business mailing address

1124 S SHIPLEY ST
MUNCIE IN
47302-3738
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1110
  • Fax: 765-288-4044
Mailing address:
  • Phone: 765-212-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: