Provider Demographics
NPI:1609026244
Name:COFFELT, KATRINA A (LPCC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:A
Last Name:COFFELT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 STATE ROUTE 121 N STE D
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8864
Mailing Address - Country:US
Mailing Address - Phone:270-761-5804
Mailing Address - Fax:
Practice Address - Street 1:1712 STATE ROUTE 121 N STE D
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8864
Practice Address - Country:US
Practice Address - Phone:270-761-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1114101YP2500X
CO5463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional