Provider Demographics
NPI:1972608230
Name:COPPOCK, TIMOTHY E (PCC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:COPPOCK
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5485 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-1440
Mailing Address - Country:US
Mailing Address - Phone:814-871-5793
Mailing Address - Fax:814-877-1511
Practice Address - Street 1:27475 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3350
Practice Address - Country:US
Practice Address - Phone:419-872-0619
Practice Address - Fax:419-872-2466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional