Provider Demographics
NPI:1942662234
Name:COFFEY, STEPHANIE COLEMAN (STEPHANIE)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:COLEMAN
Last Name:COFFEY
Suffix:
Gender:F
Credentials:STEPHANIE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38722 11TH ST E
Mailing Address - Street 2:APT. 73
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2861
Mailing Address - Country:US
Mailing Address - Phone:661-878-2756
Mailing Address - Fax:
Practice Address - Street 1:38722 11TH ST E
Practice Address - Street 2:APT. 73
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2861
Practice Address - Country:US
Practice Address - Phone:661-878-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health