MEDICARE: CHRISTINA GWENN COPELAND MS

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	101YP2500X	Professional Counselor	3525	MN

General Provider Information

NPI Number	:	1437498896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA GWENN COPELAND MS

Provider Business Mailing Address
First Line	:	1969 112TH CIR NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55449-6112
Country	:	US
Telephone Number	:	636-734-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1969 112TH CIR NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55449-6112
Country	:	US
Telephone Number	:	636-734-5511
Fax Number	:

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

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	04/24/2024

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