Provider Demographics
NPI:1194810440
Name:KOOPMAN-GLASS, MELANIE HOPE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:HOPE
Last Name:KOOPMAN-GLASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11846 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2847
Mailing Address - Country:US
Mailing Address - Phone:310-391-5093
Mailing Address - Fax:
Practice Address - Street 1:11846 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2847
Practice Address - Country:US
Practice Address - Phone:310-391-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 18794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health