Provider Demographics
NPI:1669989794
Name:RICE, CORAL L
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:L
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORAL
Other - Middle Name:L
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1713
Mailing Address - Country:US
Mailing Address - Phone:567-201-5869
Mailing Address - Fax:
Practice Address - Street 1:76 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1908
Practice Address - Country:US
Practice Address - Phone:419-448-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health