Healthcare Provider Details

I. General information

NPI: 1164786943
Provider Name (Legal Business Name): COYNE & ASSOCIATES EDUCATION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 CAMINO DEL RIO N STE 104
SAN DIEGO CA
92108-1738
US

IV. Provider business mailing address

PO BOX 231831
ENCINITAS CA
92023-1831
US

V. Phone/Fax

Practice location:
  • Phone: 760-634-1125
  • Fax: 760-634-1530
Mailing address:
  • Phone: 760-634-1125
  • Fax: 760-634-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LEN LEVIN
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 760-815-6185