Provider Demographics
NPI:1679696215
Name:COUGHLIN, BRIAN PATRICK
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7144 DUBLIN MEADOWS ST APT B
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3876
Mailing Address - Country:US
Mailing Address - Phone:408-499-4883
Mailing Address - Fax:
Practice Address - Street 1:7144 DUBLIN MEADOWS ST APT B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3876
Practice Address - Country:US
Practice Address - Phone:408-499-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor