Provider Demographics
NPI:1619283843
Name:COATES, WHITNEY BLYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:BLYNN
Last Name:COATES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:BLYNN
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0510
Mailing Address - Country:US
Mailing Address - Phone:209-550-5869
Mailing Address - Fax:209-523-0442
Practice Address - Street 1:100 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0510
Practice Address - Country:US
Practice Address - Phone:209-550-5869
Practice Address - Fax:209-523-0442
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141869101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional