Individual
MARK A COFFMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LADAC
Contact information
Practice address
110 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-1298
(479) 968-6053
Mailing address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 750-2020
(479) 750-4843
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
P0505033
AR
101YP2500X
Professional Counselor
Primary
P0505033
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227466719
—
AR
01
—
453054130
AMBETTER IRS# 453054130
AR
Enumeration date
09/27/2006
Last updated
05/01/2020
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