Provider Demographics
NPI:1366590986
Name:COATES, LAWRENCE JOHN
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:COATES
Suffix:
Gender:M
Credentials:
Other - Prefix:PROF
Other - First Name:ADVANCE
Other - Middle Name:COUNSELING
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:44709 DATE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3101
Mailing Address - Country:US
Mailing Address - Phone:661-945-6707
Mailing Address - Fax:661-942-5195
Practice Address - Street 1:44709 DATE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3101
Practice Address - Country:US
Practice Address - Phone:661-945-6707
Practice Address - Fax:661-942-5195
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY. 10063OtherLICENSED PSYCHOLOGIST