Healthcare Provider Details

I. General information

NPI: 1689025876
Provider Name (Legal Business Name): AMBER KOPPENHOFER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER SHAFFER

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 DUBLIN RD SUITE 216-C
COLUMBUS OH
43215-1000
US

IV. Provider business mailing address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

V. Phone/Fax

Practice location:
  • Phone: 614-395-8978
  • Fax:
Mailing address:
  • Phone: 740-919-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1500896-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2102127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: