Provider Demographics
NPI:1598929952
Name:KOPEN, JASON ALEXANDER (LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALEXANDER
Last Name:KOPEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LYNNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-4545
Mailing Address - Country:US
Mailing Address - Phone:303-642-3597
Mailing Address - Fax:
Practice Address - Street 1:51 LYNNWOOD LN
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:CO
Practice Address - Zip Code:80422-4545
Practice Address - Country:US
Practice Address - Phone:303-642-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical