Provider Demographics
NPI:1801089040
Name:KOPECKY, HELENA (PHD)
Entity type:Individual
Prefix:DR
First Name:HELENA
Middle Name:
Last Name:KOPECKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E CALIFORNIA BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4747
Mailing Address - Country:US
Mailing Address - Phone:626-622-3684
Mailing Address - Fax:
Practice Address - Street 1:350 S OAKLAND AVE
Practice Address - Street 2:APT. 305
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4010
Practice Address - Country:US
Practice Address - Phone:626-622-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2017-10-19
Deactivation Date:2011-06-02
Deactivation Code:
Reactivation Date:2017-10-19
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20984103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist