Basic Information
Provider Information | |||||||||
NPI: | 1831475078 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COYLE | ||||||||
FirstName: | LINDSAY | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | JOSVAI | ||||||||
OtherFirstName: | LINDSAY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4860 ROBB ST STE 201 | ||||||||
Address2: |   | ||||||||
City: | WHEAT RIDGE | ||||||||
State: | CO | ||||||||
PostalCode: | 800332162 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3032787418 | ||||||||
FaxNumber: | 8883415050 | ||||||||
Practice Location | |||||||||
Address1: | 10333 EL CAMINO REAL | ||||||||
Address2: |   | ||||||||
City: | ATASCADERO | ||||||||
State: | CA | ||||||||
PostalCode: | 934225808 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8054682000 | ||||||||
FaxNumber: | 8054686011 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2011 | ||||||||
LastUpdateDate: | 03/11/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/11/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TF0200X | PSY24109 | CA | N |   | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103TC0700X | PSY24109 | CA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.