Provider Demographics
NPI:1346653748
Name:COPPELL FAMILY THERAPY PLLC
Entity Type:Organization
Organization Name:COPPELL FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KTEILY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-544-2118
Mailing Address - Street 1:702 S DENTON TAP RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4540
Mailing Address - Country:US
Mailing Address - Phone:469-544-2118
Mailing Address - Fax:972-692-5844
Practice Address - Street 1:702 S DENTON TAP RD
Practice Address - Street 2:SUITE 140
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4540
Practice Address - Country:US
Practice Address - Phone:469-544-2118
Practice Address - Fax:972-692-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty