Healthcare Provider Details

I. General information

NPI: 1447726211
Provider Name (Legal Business Name): ELIZABETH KOPIL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8398 MISSISSIPPI ST
MERRILLVILLE IN
46410-6316
US

IV. Provider business mailing address

3605 OAK GROVE DR
VALPARAISO IN
46383-2050
US

V. Phone/Fax

Practice location:
  • Phone: 219-755-4049
  • Fax: 219-769-1048
Mailing address:
  • Phone: 708-288-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11939899
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: