Healthcare Provider Details

I. General information

NPI: 1255249611
Provider Name (Legal Business Name): EMILY R COFFEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DOCTORS PARK
GIBSON CITY IL
60936-2004
US

IV. Provider business mailing address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

V. Phone/Fax

Practice location:
  • Phone: 217-784-4540
  • Fax:
Mailing address:
  • Phone: 217-784-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178033172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: