Healthcare Provider Details

I. General information

NPI: 1528597630
Provider Name (Legal Business Name): CHRISTOPHER COPAS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11906 QUEEN ANNES CT
LOUISVILLE KY
40245-1841
US

IV. Provider business mailing address

11906 QUEEN ANNES CT
LOUISVILLE KY
40245-1841
US

V. Phone/Fax

Practice location:
  • Phone: 502-299-1559
  • Fax: 502-479-4259
Mailing address:
  • Phone: 502-299-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104775
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: