Healthcare Provider Details

I. General information

NPI: 1104437946
Provider Name (Legal Business Name): COATES & DORAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 MARIAN AVE
CARSON CITY NV
89706-2632
US

IV. Provider business mailing address

2602 BLUE HAVEN LN
CARSON CITY NV
89701-4850
US

V. Phone/Fax

Practice location:
  • Phone: 775-450-7414
  • Fax:
Mailing address:
  • Phone: 775-450-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. BODIE WARD COATES
Title or Position: OWNER
Credential: MFT, LADC
Phone: 775-450-7414