Provider Demographics
NPI:1164080412
Name:COFFEE, KRISTINE KAY (MA-LPCC, CCJP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KAY
Last Name:COFFEE
Suffix:
Gender:F
Credentials:MA-LPCC, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 JOSLYN RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2635
Mailing Address - Country:US
Mailing Address - Phone:231-571-7042
Mailing Address - Fax:
Practice Address - Street 1:1571 JOSLYN RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-2635
Practice Address - Country:US
Practice Address - Phone:231-571-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional