Provider Demographics
NPI:1396766325
Name:COPELAND, KIMBERLY (LPC)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:
Last Name:COPELAND
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 1:3717 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2037
Mailing Address - Country:US
Mailing Address - Phone:806-798-8485
Mailing Address - Fax:866-338-3730
Practice Address - Street 1:3717 27TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2037
Practice Address - Country:US
Practice Address - Phone:806-798-8485
Practice Address - Fax:866-338-3730
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026029101Medicaid
TX82358LOtherBLUECROSS
TX110789100OtherFIRST CARE