Provider Demographics
NPI:1861264574
Name:COYNE OPERATED PSYCHOTHERAPY INC
Entity type:Organization
Organization Name:COYNE OPERATED PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-322-3018
Mailing Address - Street 1:769 CENTER BLVD, PMB 125
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1764
Mailing Address - Country:US
Mailing Address - Phone:415-322-3018
Mailing Address - Fax:
Practice Address - Street 1:200 TAMAL PLZ STE 130
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1195
Practice Address - Country:US
Practice Address - Phone:415-322-3018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health