Healthcare Provider Details

I. General information

NPI: 1013089309
Provider Name (Legal Business Name): JOAN G COPPENS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JOAN S GAUVIN

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 UNIVERSITY NE OUTCOMES INC
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

1503 UNIVERSITY NE OUTCOMES INC
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-2551
  • Fax: 505-243-0446
Mailing address:
  • Phone: 505-243-2551
  • Fax: 505-243-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3321
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: