Healthcare Provider Details

I. General information

NPI: 1629307764
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL COPPOL LCSW, NBC-HWC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-4000
  • Fax:
Mailing address:
  • Phone: 502-287-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3937636
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3844
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: