Provider Demographics
NPI:1902379308
Name:SOPER, BOBBI SUE (TCADC, MSP)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:SUE
Last Name:SOPER
Suffix:
Gender:F
Credentials:TCADC, MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3032
Mailing Address - Country:US
Mailing Address - Phone:606-471-5319
Mailing Address - Fax:
Practice Address - Street 1:2150 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7734
Practice Address - Country:US
Practice Address - Phone:606-393-5926
Practice Address - Fax:606-393-5613
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169265101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor