MEDICARE: KISHA COPELAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	650848685	FL

General Provider Information

NPI Number	:	1134424013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHA COPELAND

Provider Business Mailing Address
First Line	:	11428 N 53RD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-2216
Country	:	US
Telephone Number	:	813-374-9416
Fax Number	:

Provider Business Practice Location Address
First Line	:	11428 N 53RD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-2216
Country	:	US
Telephone Number	:	813-374-9416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	01/24/2011

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Directions to “ KISHA COPELAND ” Practice Location

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