Provider Demographics
NPI:1598401572
Name:COATES, JUSTIN ANGEL (LPC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANGEL
Last Name:COATES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JUSTIN
Other - Middle Name:ANGEL
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1745 RIGGS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1621
Mailing Address - Country:US
Mailing Address - Phone:507-327-5005
Mailing Address - Fax:
Practice Address - Street 1:208 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2545
Practice Address - Country:US
Practice Address - Phone:507-327-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health