Provider Demographics
NPI:1992288914
Name:COPPER BRIDGE COUNSELING, PLLC
Entity type:Organization
Organization Name:COPPER BRIDGE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ACUNA ZAVALNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-632-3141
Mailing Address - Street 1:3005 S LAMAR BLVD # D109-231
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8864
Mailing Address - Country:US
Mailing Address - Phone:512-632-3141
Mailing Address - Fax:512-870-9789
Practice Address - Street 1:2324 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4604
Practice Address - Country:US
Practice Address - Phone:512-632-3141
Practice Address - Fax:512-870-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health