Rachel Wagner Koppa, PHD, LPC, LMFT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

59675 Issued in TX

Practice address

12720 Hillcrest Rd Ste 120
Dallas, TX 75230-2082

Phone

(214) 224-0970

NPI assigned

Jul 10, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Rachel Leah Wagner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 14, 2024 through Feb 14, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1841454675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12720 HILLCREST RD STE 120",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302082",
            "telephone_number": "214-224-0970",
            "fax_number": "214-224-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 HILLCREST RD STE 120",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302082",
            "telephone_number": "214-224-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPA",
        "first_name": "RACHEL",
        "middle_name": "WAGNER",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "201495",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "59675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHEL",
            "last_name": "WAGNER",
            "middle_name": "LEAH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Risha Kopel, M.D.
• Ellie Kopischke
• Jeffrey M. Kopita, M.D.
• Ellyn Baker Kopp, APRN, CPNP-PC
• Jamie Kay Kopp, PTA
• Venkatasuman Koppuravuri, DDS
• Raven Kopru
• Joe Ji Kor, CRNA
• Gautej Koradia, PHARM D
• Kadriye Meltem Koral, MD

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.