Provider Demographics
NPI:1740888940
Name:COFFEY, KATHY JO (LBSW)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JO
Last Name:COFFEY
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TURNING LEAF BEHAVIORAL HEALTH SERVICES, P.O. BOX 23218
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TURNING LEAF BEHAVIORAL HEALTH SERVICES
Practice Address - Street 2:621 E JOLLY RD
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48909
Practice Address - Country:US
Practice Address - Phone:517-393-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802073494104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker