Provider Demographics
NPI:1922365287
Name:KOPP, AMANDA KAY-LYNNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAY-LYNNE
Last Name:KOPP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20240 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1412
Mailing Address - Country:US
Mailing Address - Phone:248-296-6579
Mailing Address - Fax:888-390-4330
Practice Address - Street 1:20240 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1412
Practice Address - Country:US
Practice Address - Phone:248-296-6579
Practice Address - Fax:888-390-4330
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014628103TC0700X
IL071008329103TC0700X, 103TC2200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
831122039OtherIRS