Provider Demographics
NPI:1740838143
Name:KOPICH, ANDREW SMITH (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SMITH
Last Name:KOPICH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WIGWAM PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4350 E SUNSET RD STE 203
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2260
Practice Address - Country:US
Practice Address - Phone:702-547-6971
Practice Address - Fax:702-547-6948
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0-23-14278106E00000X
NV1-25-79043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1-25-79043OtherBEHAVIOR ANALYST CERTIFICATION BOARD
NV0-23-14278OtherBACB