Provider Demographics
NPI:1427112705
Name:COFFIELD, LYDIA GENE (PHD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:GENE
Last Name:COFFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CARDENAS DR SE
Mailing Address - Street 2:APARTMENT #411
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4736
Mailing Address - Country:US
Mailing Address - Phone:505-268-4247
Mailing Address - Fax:505-792-9743
Practice Address - Street 1:920 CARDENAS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1720
Practice Address - Country:US
Practice Address - Phone:505-266-8166
Practice Address - Fax:505-792-9743
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0084921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional