Provider Demographics
NPI:1053956938
Name:COPPEL, SUPIERI MOLLY (LEP #3883)
Entity type:Individual
Prefix:
First Name:SUPIERI
Middle Name:MOLLY
Last Name:COPPEL
Suffix:
Gender:F
Credentials:LEP #3883
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 ORANGETHORPE AVE STE 400A
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4902
Mailing Address - Country:US
Mailing Address - Phone:714-805-7002
Mailing Address - Fax:
Practice Address - Street 1:6131 ORANGETHORPE AVE STE 400A
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4902
Practice Address - Country:US
Practice Address - Phone:714-805-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3883103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool