Coffman, Mark A
Coffman, Mark A is an individual health care provider with primary practice located at 110 Skyline Dr , Russellville AR 72801-3362. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Coffman, Mark A can be contacted via phone (479) 968-1298.Contact Information
Primary practice address
110 Skyline Dr
Russellville AR 72801-3362
Phone: (479) 968-1298
Fax: (479) 968-6053
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | P0505033 | Arkansas |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | P0505033 | Arkansas |
Profile Details
| NPI number | 1780775288 |
|---|---|
| LBN Legal business name | Coffman, Mark A |
| Credentials | LPC, LADAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 27th, 2006 |
| Last updated | May 1st, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780775288 | NPPES |
| Arkansas | MEDICAID | 227466719 | |
| Arkansas | Other | 453054130 |
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