=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811261191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TATIANA DAUGHTREY COFFMAN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2012
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 S GILBERT RD STE 105
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-788-2898
-----------------------------------------------------
Fax | 888-553-2642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 S GILBERT RD STE 105
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-788-2898
-----------------------------------------------------
Fax | 888-553-2642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW-19413
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------