Individual
MR. JOHN H KOPPENHAVER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LCP
Contact information
Practice address
217 W IRA CT, ANDOVER, KS 67002-9469
(316) 733-5047
(316) 733-5060
Mailing address
227 N EDGEMOOR ST, WICHITA, KS 67208-4420
(316) 684-3688
(316) 684-7249
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LCP 248
KS
Other
Enumeration date
07/06/2006
Last updated
07/08/2007
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