Provider Demographics
NPI:1306977392
Name:OLD, CHRISTOPHER COFFIN (EDS, LPC, NCC, MFT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:COFFIN
Last Name:OLD
Suffix:
Gender:M
Credentials:EDS, LPC, NCC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 NORTHWOODS BLVD
Mailing Address - Street 2:BUILDING A, SUITE 1
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-6062
Mailing Address - Country:US
Mailing Address - Phone:530-582-4171
Mailing Address - Fax:530-550-1810
Practice Address - Street 1:17400 NORTHWOODS BLVD
Practice Address - Street 2:BUILDING A, SUITE 1
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-6062
Practice Address - Country:US
Practice Address - Phone:530-582-4171
Practice Address - Fax:530-550-1810
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003891101YM0800X
CAMFC 44697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health