Healthcare Provider Details

I. General information

NPI: 1396420097
Provider Name (Legal Business Name): JAMIE LYNN MCCOPPIN LCAT, RDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADWAY STE 2130
NEW YORK NY
10007-3733
US

IV. Provider business mailing address

4697 RIDGE BEND DR
NASHVILLE TN
37207-3082
US

V. Phone/Fax

Practice location:
  • Phone: 414-578-7665
  • Fax:
Mailing address:
  • Phone: 414-578-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number002850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: