Healthcare Provider Details

I. General information

NPI: 1427112705
Provider Name (Legal Business Name): LYDIA GENE COFFIELD PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CARDENAS DR NE
ALBUQUERQUE NM
87108-1720
US

IV. Provider business mailing address

1111 CARDENAS DR SE APARTMENT #411
ALBUQUERQUE NM
87108-4736
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-8166
  • Fax: 505-792-9743
Mailing address:
  • Phone: 505-268-4247
  • Fax: 505-792-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0084921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: