Individual
JESSE OLSON COPPENBARGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3624 NORTHVIEW DR, JACKSON, MS 39206-5720
(601) 503-3425
Mailing address
3624 NORTHVIEW DR, JACKSON, MS 39206-5720
(601) 503-3425
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C8634
MS
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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