1366590986 NPI number — DR. LAWRENCE JOHN COATES

Table of content: DR. LAWRENCE JOHN COATES (NPI 1366590986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366590986 NPI number — DR. LAWRENCE JOHN COATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COATES
Provider First Name:
LAWRENCE
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CENTER
Provider Other First Name:
ADVANCE
Provider Other Middle Name:
COUNSELING
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366590986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44709 DATE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-945-6707
Provider Business Mailing Address Fax Number:
661-942-5195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44709 DATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-6707
Provider Business Practice Location Address Fax Number:
661-942-5195
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170100000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY. 10063 . This is a "LICENSED PSYCHOLOGIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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