MEDICARE: DR. EDWARD LOUIS COYLE II PH.D.

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
1	103TC0700X	Clinical Psychologist	PY60719854	WA

General Provider Information

NPI Number	:	1982651709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD LOUIS COYLE II PH.D.

Provider Business Mailing Address
First Line	:	4007 BRIDGEPORT WAY W STE A
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4330
Country	:	US
Telephone Number	:	405-229-7762
Fax Number	:	253-302-4612

Provider Business Practice Location Address
First Line	:	4007 BRIDGEPORT WAY W STE A
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4330
Country	:	US
Telephone Number	:	405-229-7762
Fax Number	:	253-302-4612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	09/21/2022

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