Provider Demographics
NPI:1720422603
Name:COOVER, TONYA LYN (PCC-S)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LYN
Last Name:COOVER
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:LYN
Other - Last Name:HEFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:121 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3023
Mailing Address - Country:US
Mailing Address - Phone:614-537-0014
Mailing Address - Fax:614-567-3167
Practice Address - Street 1:121 TOWN ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3023
Practice Address - Country:US
Practice Address - Phone:614-537-0014
Practice Address - Fax:614-567-3167
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0500094 SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional