Provider Demographics
NPI:1750700514
Name:COFFRON, KAREN MICHELLE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:COFFRON
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 1:95 DECLARATION DR STE 95
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4916
Mailing Address - Country:US
Mailing Address - Phone:530-342-2566
Mailing Address - Fax:
Practice Address - Street 1:95 DECLARATION DR STE 95
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4916
Practice Address - Country:US
Practice Address - Phone:530-342-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist