MEDICARE: MARY KOPPEL

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	101Y00000X	Counselor	262044	KY

General Provider Information

NPI Number	:	1952936247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KOPPEL

Provider Business Mailing Address
First Line	:	131 ALLYSON CIR
Second Line	:
City	:	JUNCTION CITY
State	:	KY
Zip	:	40440-9041
Country	:	US
Telephone Number	:	859-494-8590
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 E SHELBY STREET
Second Line	:
City	:	JUNCTION CITY
State	:	KY
Zip	:	40440
Country	:	US
Telephone Number	:	859-325-5545
Fax Number	:

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

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	03/06/2020

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Directions to “ MARY KOPPEL ” Practice Location

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