Provider Demographics
NPI:1588172621
Name:MCLAIN COFFIN COUNSELING, LLC
Entity type:Organization
Organization Name:MCLAIN COFFIN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MCLAIN
Authorized Official - Last Name:COFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-900-4904
Mailing Address - Street 1:132 E PUTNAM AVE STE 26A
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 E PUTNAM AVE STE 26A
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2724
Practice Address - Country:US
Practice Address - Phone:203-900-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3668103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty