Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 4 | TN |
Y | 101YP2500X | Professional Counselor | 181 | TN |
NPI | 1063574259 |
---|---|
Provider Name | Dr. James R Coffman |
First Address | Ripley, TN 38063-8620 |
Second Address | Ripley, TN 38063-8620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 04/09/2012 |