1811352131 NPI number — COFFEE COUNSELING, COACHING, & CONSULTING

Table of content: (NPI 1811352131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811352131 NPI number — COFFEE COUNSELING, COACHING, & CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COFFEE COUNSELING, COACHING, & CONSULTING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811352131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 FITZHUGH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-644-4911
Provider Business Mailing Address Fax Number:
407-644-4911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2180 N PARK AVE STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32789-2358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-644-4911
Provider Business Practice Location Address Fax Number:
407-644-4911
Provider Enumeration Date:
12/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COFFEE
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
MAGNUSSON
Authorized Official Title or Position:
MANAGER/OWNER
Authorized Official Telephone Number:
407-644-4911

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MT1916 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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