Provider Demographics
NPI:1881797298
Name:COFFEY, DENNIS ALEXANDER (PH D)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ALEXANDER
Last Name:COFFEY
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:ALEXANDER
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8750 WONDERLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-1850
Mailing Address - Country:US
Mailing Address - Phone:323-650-4098
Mailing Address - Fax:323-650-4098
Practice Address - Street 1:8750 WONDERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-1850
Practice Address - Country:US
Practice Address - Phone:323-650-4098
Practice Address - Fax:323-650-4098
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12892103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12892DMedicare ID - Type Unspecified