Provider Demographics
NPI:1295728277
Name:COKER, MICHELLE C (PHD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:COKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14408 W 83RD PL
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4171
Mailing Address - Country:US
Mailing Address - Phone:913-599-6040
Mailing Address - Fax:913-599-6040
Practice Address - Street 1:6342 LONG ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2560
Practice Address - Country:US
Practice Address - Phone:913-226-5235
Practice Address - Fax:913-599-6040
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS769103TC0700X
MOPY01440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical