Basic Information
| Provider Information | |||||||||
| NPI: | 1962045518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROPER | ||||||||
| FirstName: | KODY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.ED, LPC, NCC, EMDR | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 272872 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805272872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708291062 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1575 N 4TH ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820722091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077210700 | ||||||||
| FaxNumber: | 3077211039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2019 | ||||||||
| LastUpdateDate: | 10/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC.14618 | CO | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPC.1803 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.