Provider Demographics
NPI:1043867120
Name:COFFEL, KATIE M (LPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:COFFEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 S BELHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-7612
Mailing Address - Country:US
Mailing Address - Phone:208-880-4842
Mailing Address - Fax:
Practice Address - Street 1:71 S BELHAVEN WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-7612
Practice Address - Country:US
Practice Address - Phone:208-880-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health