Provider Demographics
NPI:1063759157
Name:VAN KOPPEN, EILEEN (PSYD, MFT)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:VAN KOPPEN
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1417
Mailing Address - Country:US
Mailing Address - Phone:805-965-2503
Mailing Address - Fax:805-565-1215
Practice Address - Street 1:1010 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1417
Practice Address - Country:US
Practice Address - Phone:805-965-2503
Practice Address - Fax:805-565-1215
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT40016101YM0800X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health