Provider Demographics
NPI:1679090666
Name:COPP, GRETCHEN KYLE (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:KYLE
Last Name:COPP
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N VAN NESS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-6014
Mailing Address - Country:US
Mailing Address - Phone:559-797-6588
Mailing Address - Fax:
Practice Address - Street 1:2001 N VAN NESS BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-6014
Practice Address - Country:US
Practice Address - Phone:559-797-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9542101YM0800X
CA118485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health