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General NPI Number Information
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NPI Number | 1497246623
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Entity Type | Individual
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Provider Name | KARYN COPPOCK TAKKE
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Gender | Female
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 1465 W CENTER ST
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City | OREM
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State | UT
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Zip | 84057-5104
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Country | US
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Telephone | 801-224-2968
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Fax |
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Provider Business Mailing Address
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Address Line | 758 W 2100 N
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City | PROVO
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State | UT
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Zip | 84604-1240
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Country | US
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Telephone | 801-918-9053
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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