Individual
MR. JAMES CLINTON COFFIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
331 SIJAN AVE, WHITEMAN AIR FORCE BASE, MO 65305-1269
(660) 687-4341
(660) 687-5256
Mailing address
331 SIJAN AVE, WHITEMAN AIR FORCE BASE, MO 65305-1269
(660) 687-4341
(660) 687-5256
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2013014939
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200023710A
—
OK
01
—
709414000
BLUE CROSS BLU SHIELD
OK
Enumeration date
01/09/2006
Last updated
03/29/2018
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