Provider Demographics
NPI:1619587946
Name:KOPADDY, CHELSEY S
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:S
Last Name:KOPADDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:SEYARRA
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1108 NW ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-4607
Mailing Address - Country:US
Mailing Address - Phone:580-771-6624
Mailing Address - Fax:580-699-5520
Practice Address - Street 1:1108 NW ELM AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-4607
Practice Address - Country:US
Practice Address - Phone:580-771-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20009030OtherNOTARY COMMISSION