Provider Demographics
NPI:1114340361
Name:COPS, JAMIE (MS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:COPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:COMBINED LOCKS
Mailing Address - State:WI
Mailing Address - Zip Code:54113-1047
Mailing Address - Country:US
Mailing Address - Phone:920-470-4503
Mailing Address - Fax:
Practice Address - Street 1:615 S 8TH ST STE 210
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4468
Practice Address - Country:US
Practice Address - Phone:920-470-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2029-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional