Provider Demographics
NPI:1629475504
Name:COFFREN, RACHAEL ELAINE (LPC-ATR)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:ELAINE
Last Name:COFFREN
Suffix:
Gender:F
Credentials:LPC-ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3705
Mailing Address - Country:US
Mailing Address - Phone:970-846-2849
Mailing Address - Fax:
Practice Address - Street 1:109 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2831
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional