Provider Demographics
NPI:1992428726
Name:EDWARD L COYLE PH.D. PLLC
Entity type:Organization
Organization Name:EDWARD L COYLE PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-229-7762
Mailing Address - Street 1:4007 BRIDGEPORT WAY W STE A
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4330
Mailing Address - Country:US
Mailing Address - Phone:201-201-3215
Mailing Address - Fax:253-302-6412
Practice Address - Street 1:4007 BRIDGEPORT WAY W STE A
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4330
Practice Address - Country:US
Practice Address - Phone:201-201-3215
Practice Address - Fax:253-302-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health