Healthcare Provider Details

I. General information

NPI: 1063759157
Provider Name (Legal Business Name): EILEEN VAN KOPPEN PSYD, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 GARDEN ST
SANTA BARBARA CA
93101-1417
US

IV. Provider business mailing address

1010 GARDEN ST
SANTA BARBARA CA
93101-1417
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-2503
  • Fax: 805-565-1215
Mailing address:
  • Phone: 805-965-2503
  • Fax: 805-565-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT40016
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: