Basic Information
| Provider Information | |||||||||
| NPI: | 1215218979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COFFEE | ||||||||
| FirstName: | LETEECIA | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16538 N MAY AVE STE B | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730129007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052530071 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4149 HIGHLINE BLVD | ||||||||
| Address2: | #400 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731082103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056232370 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2011 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 251B00000X | Y | Agencies | Case Management |
No ID Information.