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General NPI Number Information
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NPI Number | 1871883280
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Entity Type | Organization
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Legal Business Name | COPLAN THERAPEUTIC MINISTRIES LLC
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1508 W LA RUA ST
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City | PENSACOLA
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State | FL
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Zip | 32501-3633
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Country | US
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Telephone | 850-529-6264
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Fax | 850-696-2347
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Provider Business Mailing Address
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Address Line | 1508 W LA RUA ST
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City | PENSACOLA
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State | FL
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Zip | 32501-3633
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Country | US
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Telephone | 850-529-6264
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Fax | 850-696-2347
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. LONNIE JAMES SWANAGAN
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Credential | LCSW
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Telephone | 850-529-6264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9413
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License Number State | FL
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