Provider Demographics
NPI:1568918795
Name:KOPPINGER, MARIA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KOPPINGER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13363 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6348
Mailing Address - Country:US
Mailing Address - Phone:702-245-3636
Mailing Address - Fax:
Practice Address - Street 1:13363 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6348
Practice Address - Country:US
Practice Address - Phone:702-245-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-52016103K00000X
106S00000X, 106S00000X
MI7401001565103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician