Healthcare Provider Details

I. General information

NPI: 1518625599
Provider Name (Legal Business Name): CAITLIN COOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 LYDA AVE
BOWLING GREEN KY
42104-3326
US

IV. Provider business mailing address

6336 BOSTON SPUR
PHILPOT KY
42366-9767
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-6567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: