Provider Demographics
NPI:1053442392
Name:KOOPMAN, DAYNEEN (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:DAYNEEN
Middle Name:
Last Name:KOOPMAN
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 K AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2131
Mailing Address - Country:US
Mailing Address - Phone:541-963-4184
Mailing Address - Fax:541-963-5272
Practice Address - Street 1:1100 K AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2131
Practice Address - Country:US
Practice Address - Phone:541-963-4184
Practice Address - Fax:541-963-5272
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health