Provider Demographics
NPI:1639901218
Name:COON-KAUFFMAN, ITANYA MARIA
Entity type:Individual
Prefix:
First Name:ITANYA
Middle Name:MARIA
Last Name:COON-KAUFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 W FRANTZ ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-7302
Mailing Address - Country:US
Mailing Address - Phone:574-265-6224
Mailing Address - Fax:
Practice Address - Street 1:1524 W FRANTZ ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-7302
Practice Address - Country:US
Practice Address - Phone:574-265-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health