Provider Demographics
NPI:1679227201
Name:KRISTA KOPCHICK LLC
Entity type:Organization
Organization Name:KRISTA KOPCHICK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOPCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CST
Authorized Official - Phone:616-402-7760
Mailing Address - Street 1:377 HASKINS CT SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7899
Mailing Address - Country:US
Mailing Address - Phone:616-402-7760
Mailing Address - Fax:
Practice Address - Street 1:1400 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5515
Practice Address - Country:US
Practice Address - Phone:616-402-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty