Provider Demographics
NPI:1346639010
Name:COFFEY, MARY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:3530 SE 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2396
Mailing Address - Country:US
Mailing Address - Phone:503-772-4335
Mailing Address - Fax:503-772-4337
Practice Address - Street 1:8716 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2531
Practice Address - Country:US
Practice Address - Phone:360-696-5300
Practice Address - Fax:360-729-3372
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2090106H00000X
WALF60807836106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist