Healthcare Provider Details

I. General information

NPI: 1568755742
Provider Name (Legal Business Name): JAMIE HOLDMAN KOPP LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2011
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 ROUNDLEAF DR
JACKSONVILLE FL
32258-5505
US

IV. Provider business mailing address

6940 ROUNDLEAF DR
JACKSONVILLE FL
32258-5505
US

V. Phone/Fax

Practice location:
  • Phone: 904-923-3605
  • Fax:
Mailing address:
  • Phone: 904-923-3605
  • Fax: 904-431-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10753
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 10753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: