Provider Demographics
NPI:1962284836
Name:KOPEIKIN, MAXWELL DANIEL (L-MFT)
Entity type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:DANIEL
Last Name:KOPEIKIN
Suffix:
Gender:M
Credentials:L-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N ELM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3422
Mailing Address - Country:US
Mailing Address - Phone:310-498-2198
Mailing Address - Fax:
Practice Address - Street 1:3150 18TH ST STE 211
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2075
Practice Address - Country:US
Practice Address - Phone:415-598-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist