Provider Demographics
NPI:1356717425
Name:COPP, BRENDALEE R (LPC)
Entity type:Individual
Prefix:
First Name:BRENDALEE
Middle Name:R
Last Name:COPP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 MOODY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1852
Mailing Address - Country:US
Mailing Address - Phone:816-304-0434
Mailing Address - Fax:
Practice Address - Street 1:9501 MOODY PARK CIR
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5128
Practice Address - Country:US
Practice Address - Phone:816-304-0434
Practice Address - Fax:913-246-0646
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2751101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
14031661OtherCAQH