Provider Demographics
NPI:1811353154
Name:COALFIELD FAMILY SERVICES, PLLC
Entity type:Organization
Organization Name:COALFIELD FAMILY SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JUDE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-648-7100
Mailing Address - Street 1:20824 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:FORT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25514-7074
Mailing Address - Country:US
Mailing Address - Phone:304-648-7100
Mailing Address - Fax:304-648-7160
Practice Address - Street 1:20824 ROUTE 52
Practice Address - Street 2:
Practice Address - City:FORT GAY
Practice Address - State:WV
Practice Address - Zip Code:25514-7074
Practice Address - Country:US
Practice Address - Phone:304-648-7100
Practice Address - Fax:304-648-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1532101YP2500X
363LF0000X, 363LP0808X
WVDP009447831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty