Provider Demographics
NPI:1578802146
Name:COFFMAN, VICKI (LMFT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29970 TECHNOLOGY DR STE 108
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2646
Mailing Address - Country:US
Mailing Address - Phone:951-900-4414
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 108
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2646
Practice Address - Country:US
Practice Address - Phone:951-900-4414
Practice Address - Fax:951-880-0817
Is Sole Proprietor?:No
Enumeration Date:2013-02-02
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83503106H00000X, 106H00000X
CAIMF70941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist