1639415177 NPI number — STEPHANIE NELSON COKER LCSW, LCDC

Table of content: STEPHANIE NELSON COKER LCSW, LCDC (NPI 1639415177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639415177 NPI number — STEPHANIE NELSON COKER LCSW, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COKER
Provider First Name:
STEPHANIE
Provider Middle Name:
NELSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASHAM
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639415177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5168 VILLAGE CREEK DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-5096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-318-9272
Provider Business Mailing Address Fax Number:
972-803-3099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5168 VILLAGE CREEK DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-5096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-318-9272
Provider Business Practice Location Address Fax Number:
972-803-3099
Provider Enumeration Date:
01/02/2013

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: 1041C0700X , with the licence number:  35454 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 12619 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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