Healthcare Provider Details

I. General information

NPI: 1306053228
Provider Name (Legal Business Name): ELIZABETH WARDWELL COPPOCK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W 92ND AVE STE 100C
FEDERAL HEIGHTS CO
80260-5269
US

IV. Provider business mailing address

2437 W DUNKELD PL
DENVER CO
80211-3737
US

V. Phone/Fax

Practice location:
  • Phone: 303-667-0345
  • Fax: 303-455-1129
Mailing address:
  • Phone: 303-667-0345
  • Fax: 303-455-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 4118
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: