Provider Demographics
NPI:1023310273
Name:COPELAND, PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:COPELAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 PALEO PINES CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-2343
Mailing Address - Country:US
Mailing Address - Phone:772-224-7649
Mailing Address - Fax:
Practice Address - Street 1:5404 PALEO PINES CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-2343
Practice Address - Country:US
Practice Address - Phone:772-224-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-20
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral