Provider Demographics
NPI:1770989188
Name:KOPP, AMANDA NICOLE (BCBA)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:NICOLE
Last Name:KOPP
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:JEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1215 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2911
Mailing Address - Country:US
Mailing Address - Phone:228-217-2997
Mailing Address - Fax:228-250-1399
Practice Address - Street 1:1215 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2911
Practice Address - Country:US
Practice Address - Phone:228-800-1810
Practice Address - Fax:228-250-1399
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2024-05-17
Deactivation Date:2023-11-06
Deactivation Code:
Reactivation Date:2023-11-21
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AL2023-054103K00000X
MS220059103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst