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General NPI Number Information
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NPI Number | 1972093409
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Entity Type | Organization
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Legal Business Name | KOPAZ COUNSELING LLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 605 WASHINGTON AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-1123
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Country | US
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Telephone | 203-864-9070
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Fax |
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Provider Business Mailing Address
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Address Line | 185 ATWATER ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-5311
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Country | US
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Telephone | 203-864-9070
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | NICHOLAS KOPAZNA
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Credential | LPC
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Telephone | 203-864-9070
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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 | 003070
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License Number State | CT
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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 | 003070
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 003070
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License Number State | CT
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