Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | RC00045112 | WA |
NPI | 1003030461 |
---|---|
Provider Name | Melvin Dahl Coplin |
First Address | Stanwood, WA 98292-5919 |
Second Address | Stanwood, WA 98292-5919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |