Provider Demographics
NPI:1053901520
Name:COOPER, MARCIA KAY (LCSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:KAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 SHADY OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-2636
Mailing Address - Country:US
Mailing Address - Phone:775-689-0220
Mailing Address - Fax:
Practice Address - Street 1:1467 SHADY OAK DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-2636
Practice Address - Country:US
Practice Address - Phone:775-689-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6060-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical