Healthcare Provider Details

I. General information

NPI: 1992428726
Provider Name (Legal Business Name): EDWARD L COYLE PH.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 BRIDGEPORT WAY W STE A
UNIVERSITY PLACE WA
98466-4330
US

IV. Provider business mailing address

4007 BRIDGEPORT WAY W STE A
UNIVERSITY PLACE WA
98466-4330
US

V. Phone/Fax

Practice location:
  • Phone: 201-201-3215
  • Fax: 253-302-6412
Mailing address:
  • Phone: 201-201-3215
  • Fax: 253-302-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD L COYLE
Title or Position: CEO
Credential: PH.D.
Phone: 405-229-7762