Provider Demographics
NPI:1194315747
Name:WHITLOCK-COATES, PRISCILLA D (LPC)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:D
Last Name:WHITLOCK-COATES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:PRISCILLA
Other - Middle Name:D
Other - Last Name:WHITLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2511 N CALLE SEIS
Mailing Address - Street 2:
Mailing Address - City:HUACHUCA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85616-8135
Mailing Address - Country:US
Mailing Address - Phone:520-227-4402
Mailing Address - Fax:
Practice Address - Street 1:333 W WILCOX DR STE 109
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1756
Practice Address - Country:US
Practice Address - Phone:520-477-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty