Provider Demographics
NPI:1568859148
Name:COFFEY LEAL, LINDA JAN (LBSW, C-SWCM)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JAN
Last Name:COFFEY LEAL
Suffix:
Gender:F
Credentials:LBSW, C-SWCM
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LBSW, C-SWCM
Mailing Address - Street 1:3537 S I 35 E
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6800
Mailing Address - Country:US
Mailing Address - Phone:940-381-2313
Mailing Address - Fax:940-381-5249
Practice Address - Street 1:3537 S I 35 E
Practice Address - Street 2:SUITE 210
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6800
Practice Address - Country:US
Practice Address - Phone:940-381-2313
Practice Address - Fax:940-381-5249
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18632104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker