Provider Demographics
NPI:1770102964
Name:COATES, TIMOTHY LAMONT II
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LAMONT
Last Name:COATES
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15827 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6896
Mailing Address - Country:US
Mailing Address - Phone:602-931-8721
Mailing Address - Fax:
Practice Address - Street 1:15827 W MONROE ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6896
Practice Address - Country:US
Practice Address - Phone:602-931-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty