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General NPI Number Information
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NPI Number | 1427424118
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Entity Type | Individual
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Provider Name | NICOLE KOPP LPC
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 112 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-5011
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Country | US
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Telephone | 208-465-5433
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Fax | 208-466-5802
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Provider Business Mailing Address
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Address Line | 112 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-5011
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Country | US
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Telephone | 208-871-3749
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Fax | 208-466-5802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5929
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-5929
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License Number State | ID
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