Provider Demographics
NPI:1215218979
Name:COFFEE, LETEECIA V
Entity type:Individual
Prefix:MRS
First Name:LETEECIA
Middle Name:V
Last Name:COFFEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 W WILSHIRE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7747
Mailing Address - Country:US
Mailing Address - Phone:405-843-2067
Mailing Address - Fax:
Practice Address - Street 1:437 W WILSHIRE BLVD STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7747
Practice Address - Country:US
Practice Address - Phone:405-843-2067
Practice Address - Fax:405-751-0110
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0801X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)