Provider Demographics
NPI:1427195528
Name:COPITCH, PHILIP (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:COPITCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 OREGON ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1719
Mailing Address - Country:US
Mailing Address - Phone:530-244-7528
Mailing Address - Fax:
Practice Address - Street 1:1650 OREGON ST
Practice Address - Street 2:SUITE 218
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1719
Practice Address - Country:US
Practice Address - Phone:530-244-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 19367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist