Provider Demographics
NPI:1639932486
Name:COPELAND, KRISTINE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:COPELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2416
Mailing Address - Country:US
Mailing Address - Phone:216-548-0732
Mailing Address - Fax:
Practice Address - Street 1:2176 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2416
Practice Address - Country:US
Practice Address - Phone:216-548-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health