Provider Demographics
NPI:1740913672
Name:KOPP, MARGARITA ALANA (LSSP, NCSP)
Entity type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:ALANA
Last Name:KOPP
Suffix:
Gender:F
Credentials:LSSP, NCSP
Other - Prefix:MRS
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:KOPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSSP, NCSP
Mailing Address - Street 1:800 COUNTY ROAD 126
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2452
Mailing Address - Country:US
Mailing Address - Phone:503-686-3329
Mailing Address - Fax:
Practice Address - Street 1:800 COUNTY ROAD 126
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-2452
Practice Address - Country:US
Practice Address - Phone:503-686-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR145660103TS0200X
TX71086103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool