=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538255328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA ROBIN KOPSTEIN MA, MFT INTERN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 S HARBOR BLVD SUITE 200
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-6823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-966-8695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27285 VIANA
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92692-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-929-4077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | IMF 44716
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------