Provider Demographics
NPI:1841454675
Name:KOPPA, RACHEL WAGNER (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:WAGNER
Last Name:KOPPA
Suffix:
Gender:F
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LEAH
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12720 HILLCREST RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2082
Mailing Address - Country:US
Mailing Address - Phone:214-224-0970
Mailing Address - Fax:214-224-0970
Practice Address - Street 1:12720 HILLCREST RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2082
Practice Address - Country:US
Practice Address - Phone:214-224-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201495106H00000X
TX59675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist