Provider Demographics
NPI:1568294213
Name:COFFEE, EMILY ANN REDE (LMFT, AT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN REDE
Last Name:COFFEE
Suffix:
Gender:F
Credentials:LMFT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4306
Mailing Address - Country:US
Mailing Address - Phone:415-706-5980
Mailing Address - Fax:
Practice Address - Street 1:4400 CAPITOLA RD STE 200
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3571
Practice Address - Country:US
Practice Address - Phone:831-426-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
139422106H00000X
221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist