Provider Demographics
NPI:1215149885
Name:KOPPERT, BRUCE JEFFREY (LPCC)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:JEFFREY
Last Name:KOPPERT
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 COOPER RD
Mailing Address - Street 2:STE. 209
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8780
Mailing Address - Country:US
Mailing Address - Phone:614-898-8890
Mailing Address - Fax:
Practice Address - Street 1:495 COOPER RD
Practice Address - Street 2:STE. 209
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8780
Practice Address - Country:US
Practice Address - Phone:614-898-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional