Healthcare Provider Details

I. General information

NPI: 1780507863
Provider Name (Legal Business Name): COFFEY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 BOYLSTON ST FL 5
BOSTON MA
02116-2774
US

IV. Provider business mailing address

867 BOYLSTON ST FL 5
BOSTON MA
02116-2774
US

V. Phone/Fax

Practice location:
  • Phone: 913-218-9554
  • Fax:
Mailing address:
  • Phone: 913-218-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AUSTIN COFFEY-MOORE
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 617-297-8287