Provider Demographics
NPI:1194862193
Name:COFFMAN, DANIEL A (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10556 COMBIE RD
Mailing Address - Street 2:PMB 6311
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8908
Mailing Address - Country:US
Mailing Address - Phone:530-632-3997
Mailing Address - Fax:
Practice Address - Street 1:991 LINCOLN WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5249
Practice Address - Country:US
Practice Address - Phone:530-632-3997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical