Provider Demographics
NPI:1265996730
Name:COATES, LOARY VIOLA (MENTAL HEALTH COUNSE)
Entity type:Individual
Prefix:
First Name:LOARY
Middle Name:VIOLA
Last Name:COATES
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 SAN PALERMO DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-2374
Mailing Address - Country:US
Mailing Address - Phone:715-245-0032
Mailing Address - Fax:
Practice Address - Street 1:3224 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7201
Practice Address - Country:US
Practice Address - Phone:941-315-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1600103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1600OtherLICENSE