Provider Demographics
NPI:1447253174
Name:KOPECKY, JENNIFER E (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:KOPECKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 SAFE HARBOUR CIR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-7414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:STE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-6400
Practice Address - Country:US
Practice Address - Phone:281-996-8373
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00106PMedicare ID - Type Unspecified