Basic Information
| Provider Information | |||||||||
| NPI: | 1568859148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COFFEY LEAL | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | JAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LBSW, C-SWCM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEAL | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LBSW, C-SWCM | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3537 S I 35 E | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762106800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403812313 | ||||||||
| FaxNumber: | 9403815249 | ||||||||
| Practice Location | |||||||||
| Address1: | 3537 S I 35 E | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762106800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403812313 | ||||||||
| FaxNumber: | 9403815249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 18632 | TX | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.