Provider Demographics
NPI:1679659833
Name:COUPLAND, MARY ANN (LP)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:COUPLAND
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E 3RD ST
Mailing Address - Street 2:PO BOX 150
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-1810
Mailing Address - Country:US
Mailing Address - Phone:402-376-1519
Mailing Address - Fax:
Practice Address - Street 1:ANTELOPE LAKE CIRCLE DRIVE
Practice Address - Street 2:MULTIPURPOSE BUILDING RM 128
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555
Practice Address - Country:US
Practice Address - Phone:605-856-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical