Healthcare Provider Details

I. General information

NPI: 1598929952
Provider Name (Legal Business Name): JASON ALEXANDER KOPEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 LYNNWOOD LN
BLACK HAWK CO
80422-4545
US

IV. Provider business mailing address

51 LYNNWOOD LN
BLACK HAWK CO
80422-4545
US

V. Phone/Fax

Practice location:
  • Phone: 303-642-3597
  • Fax:
Mailing address:
  • Phone: 303-642-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number647
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: