Healthcare Provider Details

I. General information

NPI: 1063574259
Provider Name (Legal Business Name): JAMES R COFFMAN D MIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CURVE WOODVILLE ROAD COFFMAN AND COMPANY
RIPLEY TN
38063-8620
US

IV. Provider business mailing address

2112 CUVE WOODVILLE ROAD COFFMAN AND COMPANY
RIPLEY TN
38063-8620
US

V. Phone/Fax

Practice location:
  • Phone: 731-612-8544
  • Fax: 731-612-8544
Mailing address:
  • Phone: 731-612-8544
  • Fax: 731-635-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number4
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number181
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: