Provider Demographics
NPI:1346219508
Name:COFFEN, RONALD DUANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DUANE
Last Name:COFFEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4195 ADMINISTRATION DR
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49104-0001
Mailing Address - Country:US
Mailing Address - Phone:269-471-3491
Mailing Address - Fax:269-471-3491
Practice Address - Street 1:1045 E FRONT ST STE B4
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-8474
Practice Address - Country:US
Practice Address - Phone:269-471-3491
Practice Address - Fax:269-471-3491
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012485103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist