Provider Demographics
NPI:1134403843
Name:KOPF, RYAN HARRIS
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:HARRIS
Last Name:KOPF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CLOVERLEAF CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7269
Mailing Address - Country:US
Mailing Address - Phone:804-742-0040
Mailing Address - Fax:
Practice Address - Street 1:4 CLOVERLEAF CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7269
Practice Address - Country:US
Practice Address - Phone:804-742-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-14-17623103K00000X, 103K00000X
CA1-14-16549103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst