Provider Demographics
NPI:1235657032
Name:COPAS, MIRANDA DAWN (LPCC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DAWN
Last Name:COPAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WAYNOKA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9286
Mailing Address - Country:US
Mailing Address - Phone:937-798-0209
Mailing Address - Fax:
Practice Address - Street 1:3964 WHEAT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693
Practice Address - Country:US
Practice Address - Phone:937-544-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health