Healthcare Provider Details

I. General information

NPI: 1447607346
Provider Name (Legal Business Name): KATIE ELISE KOPAN MAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 METRO BLVD 413
EDINA MN
55439-2316
US

IV. Provider business mailing address

3020 W 28TH ST 4
MINNEAPOLIS MN
55416-4369
US

V. Phone/Fax

Practice location:
  • Phone: 612-598-1414
  • Fax:
Mailing address:
  • Phone: 612-718-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: