Provider Demographics
NPI:1346954757
Name:COATS, LYIA NIKOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYIA
Middle Name:NIKOLE
Last Name:COATS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1836
Mailing Address - Country:US
Mailing Address - Phone:708-769-0015
Mailing Address - Fax:
Practice Address - Street 1:3237 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1836
Practice Address - Country:US
Practice Address - Phone:708-769-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0166031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty