MEDICARE: RAVEN COLEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-18-56410	OTHER		BACB

General Provider Information

NPI Number	:	1134683295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN COLEMAN

Provider Business Mailing Address
First Line	:	2225 COUNTY ROAD 90 STE 109
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-4891
Country	:	US
Telephone Number	:	281-760-1445
Fax Number	:	713-583-2027

Provider Business Practice Location Address
First Line	:	2225 COUNTY ROAD 90 STE 109
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-4891
Country	:	US
Telephone Number	:	281-760-1445
Fax Number	:	713-583-2027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/13/2026

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Directions to “ RAVEN COLEMAN ” Practice Location

Language	Start Address	Practice Location

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