Provider Demographics
NPI:1811261191
Name:DAUGHTREY COFFMAN, TATIANA (LCSW, IBCLC, PMH-C)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:DAUGHTREY COFFMAN
Suffix:
Gender:F
Credentials:LCSW, IBCLC, PMH-C
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:INDRISEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:428 S GILBERT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:428 S GILBERT RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2261
Practice Address - Country:US
Practice Address - Phone:480-788-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-03
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-21963174N00000X, 174N00000X
AZLCSW-194131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty