MEDICARE: HEATHER COLEMAN PHD

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	103TC0700X	Clinical Psychologist	PSY25946	CA

General Provider Information

NPI Number	:	1245380211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER COLEMAN PHD

Provider Business Mailing Address
First Line	:	200 24TH ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1804
Country	:	US
Telephone Number	:	510-412-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 24TH ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1804
Country	:	US
Telephone Number	:	510-412-9210
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/10/2020

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Directions to “ HEATHER COLEMAN PHD” Practice Location

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