Individual
LEATANYA KOPPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6606 W CENTRAL AVE, WICHITA, KS 67212-3315
(316) 221-2661
(316) 636-1190
Mailing address
6606 W CENTRAL AVE, WICHITA, KS 67212-3315
(316) 221-2661
(316) 636-1190
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
03287
KS
101YP2500X
Professional Counselor
Primary
3178
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004590570003
—
KS
Enumeration date
03/15/2018
Last updated
03/02/2023
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