Provider Demographics
NPI:1952527798
Name:COFFMAN, GRISELDA LIAMARA (MA)
Entity Type:Individual
Prefix:MRS
First Name:GRISELDA
Middle Name:LIAMARA
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:LIAMARA
Other - Last Name:COFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:2811 SAN JUAN LN
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5617
Mailing Address - Country:US
Mailing Address - Phone:714-307-4963
Mailing Address - Fax:
Practice Address - Street 1:2130 E 4TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3818
Practice Address - Country:US
Practice Address - Phone:714-543-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT109615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist