Provider Demographics
NPI:1437498896
Name:COPELAND, CHRISTINA GWENN (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GWENN
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 112TH CIR NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6112
Mailing Address - Country:US
Mailing Address - Phone:636-734-5511
Mailing Address - Fax:
Practice Address - Street 1:1833 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2424
Practice Address - Country:US
Practice Address - Phone:763-421-5535
Practice Address - Fax:763-433-0226
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional