Basic Information
| Provider Information | |||||||||
| NPI: | 1720618358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPE | ||||||||
| FirstName: | ANJA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3459 LANDING VW | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327782062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295486223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 W MAIN ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347482842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523143760 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2020 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-20-44199 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.