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NPI Code Detail

MEDICARE: KISHA COPELAND

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
1101YM0800XMental Health Counselor650848685FL

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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