Provider Demographics
NPI:1235923376
Name:COFFELT COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:COFFELT COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGGENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:LMCH, LCPC
Authorized Official - Phone:563-210-2359
Mailing Address - Street 1:1312 CHATEAU KNLS
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3417
Mailing Address - Country:US
Mailing Address - Phone:563-210-2359
Mailing Address - Fax:
Practice Address - Street 1:2117 STATE ST STE 250
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5164
Practice Address - Country:US
Practice Address - Phone:563-949-1124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.011632OtherLCPC
IA072145OtherLMHC