Provider Demographics
NPI:1215613799
Name:COPPESS, CASEY DEAN
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:DEAN
Last Name:COPPESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5553 N GLENWOOD AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1259
Mailing Address - Country:US
Mailing Address - Phone:515-979-6965
Mailing Address - Fax:
Practice Address - Street 1:3354 N PAULINA ST STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1087
Practice Address - Country:US
Practice Address - Phone:773-234-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health