Provider Demographics
NPI:1013381771
Name:COAN, DAVID I (CSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COAN
Suffix:I
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N 1150 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2343
Mailing Address - Country:US
Mailing Address - Phone:435-559-1067
Mailing Address - Fax:435-586-4268
Practice Address - Street 1:17 N 1150 W
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2343
Practice Address - Country:US
Practice Address - Phone:435-559-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT357005-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health