Healthcare Provider Details

I. General information

NPI: 1396017778
Provider Name (Legal Business Name): AMY L. COPELAND PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COLONIAL DR
BATON ROUGE LA
70806-6511
US

IV. Provider business mailing address

740 COLONIAL DR
BATON ROUGE LA
70806-6511
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-9422
  • Fax: 225-216-1260
Mailing address:
  • Phone: 225-216-9422
  • Fax: 225-216-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number854
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number854
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number854
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number854
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number854
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number854
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: