=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891296281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS GEORGE COATES MA, LPC, ICGC-1
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2018
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13101 ALLEN RD
-----------------------------------------------------
City | SOUTHGATE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48195-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-785-7700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9600 VICTORIA LN APT 107
-----------------------------------------------------
City | TAYLOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48180-7512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-815-2321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6401007786
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------