Provider Demographics
NPI:1720562598
Name:COKER, JONI (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:COKER
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29957 STATE HIGHWAY 64 STE 108
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-3413
Mailing Address - Country:US
Mailing Address - Phone:469-644-3301
Mailing Address - Fax:
Practice Address - Street 1:29957 STATE HIGHWAY 64 STE 108
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-3413
Practice Address - Country:US
Practice Address - Phone:469-644-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14109101YA0400X
TX76222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)