Provider Demographics
NPI:1134989528
Name:COPENHAVER, ALLAN
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:
Last Name:COPENHAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:COPENHAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1207 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1207 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3009
Practice Address - Country:US
Practice Address - Phone:906-273-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511169531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical