Provider Demographics
NPI:1720840580
Name:COFFMAN, HEIDI A (LLC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-5129
Mailing Address - Country:US
Mailing Address - Phone:586-713-8585
Mailing Address - Fax:
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-5129
Practice Address - Country:US
Practice Address - Phone:586-713-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health