Provider Demographics
NPI:1922746718
Name:KOPP, CARLYE GRACE
Entity type:Individual
Prefix:
First Name:CARLYE
Middle Name:GRACE
Last Name:KOPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S MONACO PKWY APT 50
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1875
Mailing Address - Country:US
Mailing Address - Phone:720-989-1077
Mailing Address - Fax:
Practice Address - Street 1:1250 S MONACO PKWY APT 50
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1875
Practice Address - Country:US
Practice Address - Phone:817-729-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional