Basic Information
| Provider Information | |||||||||
| NPI: | 1760669162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COFFEY II | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13101 ALLEN ROAD | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347857704 | ||||||||
| FaxNumber: | 7347857734 | ||||||||
| Practice Location | |||||||||
| Address1: | 13101 ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347857704 | ||||||||
| FaxNumber: | 7347857734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801089965 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.