MEDICARE: MIYUKI COIRIN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMFT51225	CA

General Provider Information

NPI Number	:	1568641884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIYUKI COIRIN LMFT

Provider Business Mailing Address
First Line	:	221 TUXEDO CT STE F
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5261
Country	:	US
Telephone Number	:	209-505-7812
Fax Number	:	209-475-8090

Provider Business Practice Location Address
First Line	:	221 TUXEDO CT STE F
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5261
Country	:	US
Telephone Number	:	209-505-7812
Fax Number	:	209-475-8090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	03/17/2018

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