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NPI Code Detail

MEDICARE: EMILY ANN REDE COFFEE LMFT, AT

MEDICARE: EMILY ANN REDE COFFEE LMFT, AT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist139422
2221700000XArt Therapist

General Provider Information

NPI Number : 1568294213
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY ANN REDE COFFEE LMFT, AT
Provider Business Mailing Address
First Line : 1021 30TH AVE
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95062-4306
Country : US
Telephone Number : 415-706-5980
Fax Number :
Provider Business Practice Location Address
First Line : 4400 CAPITOLA RD STE 200
Second Line :
City : CAPITOLA
State : CA
Zip : 95010-3571
Country : US
Telephone Number : 831-426-9302
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2024
Last Update Date : 08/20/2024

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