Healthcare Provider Details

I. General information

NPI: 1477919967
Provider Name (Legal Business Name): AUBREY KOPCZYNSKI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUBREY MALOUF LMHC

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 1ST ST NW
ALBUQUERQUE NM
87102-2355
US

IV. Provider business mailing address

501 CARLISLE BLVD SE
ALBUQUERQUE NM
87106-1507
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-9777
  • Fax:
Mailing address:
  • Phone: 505-228-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0177841
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: