Provider Demographics
NPI:1629458393
Name:KOPPIN, TERESA (LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:KOPPIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3196
Mailing Address - Country:US
Mailing Address - Phone:719-251-5222
Mailing Address - Fax:
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3196
Practice Address - Country:US
Practice Address - Phone:719-251-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011162101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional