Provider Demographics
NPI:1700466158
Name:LOPER, KENZIE
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:LOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2649
Mailing Address - Country:US
Mailing Address - Phone:903-705-5592
Mailing Address - Fax:
Practice Address - Street 1:101 S LOCUST ST STE 602
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6159
Practice Address - Country:US
Practice Address - Phone:972-499-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health