Provider Demographics
NPI:1174884506
Name:BOPP, JACQUELYNE ECHO (LMHC)
Entity type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:ECHO
Last Name:BOPP
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JACQUELYNE
Other - Middle Name:ECHO
Other - Last Name:GINNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 HAYNER HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4593
Mailing Address - Country:US
Mailing Address - Phone:315-480-7026
Mailing Address - Fax:
Practice Address - Street 1:634 PLANK RD STE 206
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4881
Practice Address - Country:US
Practice Address - Phone:518-456-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health