Provider Demographics
NPI:1932100260
Name:COE, DAVID MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:COE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2609
Mailing Address - Country:US
Mailing Address - Phone:440-593-2630
Mailing Address - Fax:440-599-9074
Practice Address - Street 1:438 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2609
Practice Address - Country:US
Practice Address - Phone:440-593-2630
Practice Address - Fax:440-599-9074
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001896101YM0800X
OH5909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000363003OtherANTHEM BLUE SHIELD
OH000000363003OtherUNICARE
OH2530523Medicaid
OH000000363003OtherANTHEM BLUE SHIELD
OHP00171507Medicare PIN