Doctor Name: | CRYSTAL COPENHAVER |
NPI Number: | 1043615545 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | |
Business Practice Address: | 702 Sunset Dr Ontario, OR - 979143121 |
Business Phone Number: | 5418899167 |
Business Fax Number: | |
Mailing Address: | 702 Sunset Dr, ONTARIO |
State: | OR |
Postal Code: | 979143121 |
Phone Number: | 5418899167 |
Fax Number: | |
NPI Enumeration Date: | 10/27/2014 |
NPI Last Update Date: | 10/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |