Provider Demographics
NPI:1447607346
Name:KOPAN, KATIE ELISE (MAMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELISE
Last Name:KOPAN
Suffix:
Gender:F
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 W 28TH ST
Mailing Address - Street 2:4
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4369
Mailing Address - Country:US
Mailing Address - Phone:612-718-1213
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD
Practice Address - Street 2:413
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2316
Practice Address - Country:US
Practice Address - Phone:612-598-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1992808844OtherSUPERVISORS INDIVIDUAL NPI NUMBER JANET M ANDERSON, LICSW
MN1891819686Medicaid