MEDICARE: MR. ERIC JOHN COPELAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	104100000X	Social Worker	ASW 29796	CA

General Provider Information

NPI Number	:	1407005036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC JOHN COPELAND

Provider Business Mailing Address
First Line	:	967 N PARK CIR
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4030
Country	:	US
Telephone Number	:	562-277-0831
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W BROADWAY STE 5050
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4456
Country	:	US
Telephone Number	:	562-285-1330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	07/09/2013

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