Provider Demographics
NPI:1447634720
Name:HEIDI KOOP COUNSELING AND CONSULTING LLC
Entity type:Organization
Organization Name:HEIDI KOOP COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-987-2296
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0486
Mailing Address - Country:US
Mailing Address - Phone:808-987-2296
Mailing Address - Fax:
Practice Address - Street 1:81-6161 D ROAD
Practice Address - Street 2:
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:96704
Practice Address - Country:US
Practice Address - Phone:808-987-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-32681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty