Provider Demographics
NPI:1114074598
Name:KOPP, LORI R (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:R
Last Name:KOPP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 SILVERWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7937
Mailing Address - Country:US
Mailing Address - Phone:406-458-7018
Mailing Address - Fax:
Practice Address - Street 1:616 HELENA AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3654
Practice Address - Country:US
Practice Address - Phone:406-449-3120
Practice Address - Fax:406-449-3125
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0502299Medicaid