Provider Demographics
NPI:1427324078
Name:KOPECKY, STEPHANIE ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:KOPECKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KOPECKY
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:201 E MYRTLE ST
Mailing Address - Street 2:STE 139
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4763
Mailing Address - Country:US
Mailing Address - Phone:979-299-8548
Mailing Address - Fax:281-966-1692
Practice Address - Street 1:100 EAGLE NEST CT
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:TX
Practice Address - Zip Code:77566-4765
Practice Address - Country:US
Practice Address - Phone:979-299-8548
Practice Address - Fax:281-966-1692
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2938631-02Medicaid