Provider Demographics
NPI:1639393531
Name:DAVID B. COPPEL, PH.D., P.S.
Entity Type:Organization
Organization Name:DAVID B. COPPEL, PH.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:COPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-822-1988
Mailing Address - Street 1:1104 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5441
Mailing Address - Country:US
Mailing Address - Phone:425-822-1988
Mailing Address - Fax:425-889-8362
Practice Address - Street 1:1104 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5441
Practice Address - Country:US
Practice Address - Phone:425-822-1988
Practice Address - Fax:425-889-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA802103G00000X, 103TC0700X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO8141OtherREGENCE BLUE SHIELD ID#
WA148927100000OtherPREMERA BLUE CROSS ID#