=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720469786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE COPE CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2015
-----------------------------------------------------
Last Update Date | 06/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 888 WEST SAM HOUSTON PARKWAY SOUTH SUITE 135
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-304-4484
-----------------------------------------------------
Fax | 832-218-5019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 888 WEST SAM HOUSTON PARKWAY SOUTH SUITE 135
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-304-4484
-----------------------------------------------------
Fax | 832-218-5019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST/OWNER
-----------------------------------------------------
Name | MS. MARISHA N COPELAND
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 832-304-4484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 66366
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 66366
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 66366
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------