Provider Demographics
NPI:1447809330
Name:COYLE, PATRICK VINCENT (LPC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:VINCENT
Last Name:COYLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 BARBADOS
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4931
Mailing Address - Country:US
Mailing Address - Phone:940-447-4769
Mailing Address - Fax:
Practice Address - Street 1:4500 BARBADOS
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4931
Practice Address - Country:US
Practice Address - Phone:940-447-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health