Provider Demographics
NPI:1295538270
Name:THE COPA KRAWLER LLC
Entity type:Organization
Organization Name:THE COPA KRAWLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-BHP
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-868-9846
Mailing Address - Street 1:35444 W SAN ALVAREZ AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3702
Mailing Address - Country:US
Mailing Address - Phone:480-828-6198
Mailing Address - Fax:
Practice Address - Street 1:35444 W SAN ALVAREZ AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3702
Practice Address - Country:US
Practice Address - Phone:480-868-9846
Practice Address - Fax:520-280-0598
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGINA D THOMPSON LCSW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ170471Medicaid