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NPI Code Detail

MEDICARE: COLEMAN PROFESSIONAL SERVICES

MEDICARE: COLEMAN PROFESSIONAL SERVICES
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
1101YM0800XMental Health Counselor0227OH
2251S00000XCommunity/Behavioral Health Agency0227OH

General Provider Information

NPI Number : 1245307966
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLEMAN PROFESSIONAL SERVICES
Provider Business Mailing Address
First Line : 5982 RHODES RD
Second Line :
City : KENT
State : OH
Zip : 44240-4128
Country : US
Telephone Number : 330-673-1347
Fax Number : 330-678-3677
Provider Business Practice Location Address
First Line : 320 HIGH ST NE
Second Line :
City : WARREN
State : OH
Zip : 44481-1222
Country : US
Telephone Number : 330-393-1175
Fax Number : 330-394-5910
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : MRS. DIANA D. KEATHLEY
Credential :
Telephone Number : 330-676-6826
Provider Enumeration Date : 11/29/2006
Last Update Date : 10/23/2007

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Directions to “COLEMAN PROFESSIONAL SERVICES ” Practice Location

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