Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 38161 | TX |
NPI | 1104058627 |
---|---|
Provider Name | Ksenia Kopeikin |
First Address | Austin, TX 78746-5753 |
Second Address | Austin, TX 78746-5753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2009 |
Last Update Date | 15/04/2019 |