Provider Demographics
NPI:1982424735
Name:COPELAND, GRACE JORGENSEN (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:JORGENSEN
Last Name:COPELAND
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ELIZABETH
Other - Last Name:JORGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9210 EWERS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2521
Mailing Address - Country:US
Mailing Address - Phone:901-604-2451
Mailing Address - Fax:
Practice Address - Street 1:625 MERAMEC STATION RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5550
Practice Address - Country:US
Practice Address - Phone:314-626-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024003577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health