Provider Demographics
NPI:1841474889
Name:COUGHLIN, PATRICIA CAROL (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CAROL
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:CAROL
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11349 CRAGWOLD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7010
Mailing Address - Country:US
Mailing Address - Phone:314-965-3466
Mailing Address - Fax:314-835-0021
Practice Address - Street 1:13610 BARRETT OFFICE DR.
Practice Address - Street 2:SUITE 210
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63021
Practice Address - Country:US
Practice Address - Phone:314-662-0557
Practice Address - Fax:314-835-0021
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW000750101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor