Healthcare Provider Details

I. General information

NPI: 1497663090
Provider Name (Legal Business Name): COFFEE TALK THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 N 3RD WAY
RIDGEFIELD WA
98642-7308
US

IV. Provider business mailing address

2905 N 3RD WAY
RIDGEFIELD WA
98642-7308
US

V. Phone/Fax

Practice location:
  • Phone: 661-313-1113
  • Fax: 855-951-0175
Mailing address:
  • Phone: 661-313-1113
  • Fax: 855-951-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE SUSAN SUFFIELD
Title or Position: OWNER/CLINICIAN
Credential: LMFT
Phone: 661-313-1113