Provider Demographics
NPI:1154163160
Name:COYOTE, JUAN (LPCC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:COYOTE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 FOOTHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9828
Mailing Address - Country:US
Mailing Address - Phone:719-580-8317
Mailing Address - Fax:
Practice Address - Street 1:7257 FOOTHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-9828
Practice Address - Country:US
Practice Address - Phone:719-580-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health