Provider Demographics
NPI:1053301531
Name:COFFMAN, MARILYN A (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:A
Last Name:COFFMAN
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 1:525 RUE SAINT FRANCOIS
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5036
Mailing Address - Country:US
Mailing Address - Phone:314-837-9507
Mailing Address - Fax:314-837-9507
Practice Address - Street 1:525 RUE SAINT FRANCOIS
Practice Address - Street 2:SUITE 7
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5036
Practice Address - Country:US
Practice Address - Phone:314-837-9507
Practice Address - Fax:314-837-9507
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS 001195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health