Healthcare Provider Details

I. General information

NPI: 1215149885
Provider Name (Legal Business Name): BRUCE JEFFREY KOPPERT LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 COOPER RD STE. 209
WESTERVILLE OH
43081-8780
US

IV. Provider business mailing address

495 COOPER RD STE. 209
WESTERVILLE OH
43081-8780
US

V. Phone/Fax

Practice location:
  • Phone: 614-898-8890
  • Fax:
Mailing address:
  • Phone: 614-898-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE2416
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: