Healthcare Provider Details

I. General information

NPI: 1376754549
Provider Name (Legal Business Name): CHARLES E COULL LMFT, PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 E CHAPMAN AVE
ORANGE CA
92866-1621
US

IV. Provider business mailing address

PO BOX 1174
TUSTIN CA
92781-1174
US

V. Phone/Fax

Practice location:
  • Phone: 714-598-8123
  • Fax: 949-387-1830
Mailing address:
  • Phone: 714-598-8123
  • Fax: 949-387-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC19977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: