Provider Demographics
NPI:1972970820
Name:COYNE, MARY TERESA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:TERESA
Last Name:COYNE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 FIGUEROA ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2756
Mailing Address - Country:US
Mailing Address - Phone:805-231-7591
Mailing Address - Fax:
Practice Address - Street 1:143 FIGUEROA ST
Practice Address - Street 2:SUITE E
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2756
Practice Address - Country:US
Practice Address - Phone:805-231-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist