Provider Demographics
NPI:1164741625
Name:KOPANIASZ, ASHLEY L (MA, LPCC, LCDCIII)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:KOPANIASZ
Suffix:
Gender:F
Credentials:MA, LPCC, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-5695
Mailing Address - Fax:419-383-3031
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-383-5695
Practice Address - Fax:419-383-3031
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600555101YA0400X
OHLICDC.0810282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry