Provider Demographics
NPI:1447766365
Name:COUGHLIN, KIMBERLEY ANN (MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 PEACH ST STE 185
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2125
Mailing Address - Country:US
Mailing Address - Phone:814-480-8985
Mailing Address - Fax:814-480-8947
Practice Address - Street 1:1611 PEACH ST STE 185
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2125
Practice Address - Country:US
Practice Address - Phone:814-480-8985
Practice Address - Fax:814-480-8947
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health