Healthcare Provider Details

I. General information

NPI: 1487165080
Provider Name (Legal Business Name): CHRISTI COPELAND MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FOSTER LN
JARRELL TX
76537-1198
US

IV. Provider business mailing address

220 FOSTER LN
JARRELL TX
76537-1198
US

V. Phone/Fax

Practice location:
  • Phone: 512-639-1633
  • Fax:
Mailing address:
  • Phone: 512-639-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number78117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: