Provider Demographics
NPI:1508353483
Name:COFFMAN, KRIS
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BROADWAY STE 502
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3812
Mailing Address - Country:US
Mailing Address - Phone:707-440-9299
Mailing Address - Fax:
Practice Address - Street 1:3300 BROADWAY STE 502
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3812
Practice Address - Country:US
Practice Address - Phone:707-440-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT131324106H00000X
CAAMFT104301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist