Provider Demographics
NPI:1508540303
Name:COALFIELD FAMILY SERVICES, PLLC
Entity Type:Organization
Organization Name:COALFIELD FAMILY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:JUDE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-648-7100
Mailing Address - Street 1:20824 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:FORT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25514-7074
Mailing Address - Country:US
Mailing Address - Phone:304-648-7100
Mailing Address - Fax:
Practice Address - Street 1:20824 ROUTE 52
Practice Address - Street 2:
Practice Address - City:FORT GAY
Practice Address - State:WV
Practice Address - Zip Code:25514-7074
Practice Address - Country:US
Practice Address - Phone:304-648-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)