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General NPI Number Information
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NPI Number | 1285924225
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Entity Type | Individual
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Provider Name | JAMES W COUGHLIN M.A.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 906 STRAWBERRY CT
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City | NIXA
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State | MO
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Zip | 65714-9706
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Country | US
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Telephone | 417-708-5684
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8944
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City | SPRINGFIELD
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State | MO
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Zip | 65801-8944
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2011009510
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License Number State | MO
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