Provider Demographics
NPI:1053386094
Name:COFFMAN, MATTHEW D (MA, PCC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:MA, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25700 SCIENCE PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7328
Mailing Address - Country:US
Mailing Address - Phone:216-450-1613
Mailing Address - Fax:216-450-1614
Practice Address - Street 1:25700 SCIENCE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7328
Practice Address - Country:US
Practice Address - Phone:216-450-1613
Practice Address - Fax:216-450-1614
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0003625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional