Provider Demographics
NPI:1780912899
Name:COKER, JEFFERY GRADY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:GRADY
Last Name:COKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PINE AVE
Mailing Address - Street 2:STE 608
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2310
Mailing Address - Country:US
Mailing Address - Phone:562-595-3955
Mailing Address - Fax:562-315-3005
Practice Address - Street 1:320 PINE AVE
Practice Address - Street 2:STE 608
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2310
Practice Address - Country:US
Practice Address - Phone:562-595-3955
Practice Address - Fax:562-315-3005
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical