1437515046 NPI number — JAMIE H. KOPP

Table of content: (NPI 1437515046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437515046 NPI number — JAMIE H. KOPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMIE H. KOPP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KOPP'S COUNSELING AND CONSULTING SERVICES, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437515046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10010 SKINNER LAKE DR
Provider Second Line Business Mailing Address:
UNIT 922
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32246-8408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-891-2576
Provider Business Mailing Address Fax Number:
904-743-9289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8825 PERIMETER PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-891-2576
Provider Business Practice Location Address Fax Number:
904-743-9289
Provider Enumeration Date:
01/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KOPP
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
HOLDMAN
Authorized Official Title or Position:
LICENSED MENTAL HEALTH COUNSELOR
Authorized Official Telephone Number:
904-891-2576

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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