Provider Demographics
NPI:1376688374
Name:KOPPERS, JACQUELINE K (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:K
Last Name:KOPPERS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:KRISTINE
Other - Last Name:KOPPERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 BARRANCA PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4780
Mailing Address - Country:US
Mailing Address - Phone:925-282-1778
Mailing Address - Fax:
Practice Address - Street 1:4040 BARRANCA PKWY STE 260
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4780
Practice Address - Country:US
Practice Address - Phone:925-282-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical