MEDICARE: MS. ELEXIS E. COLEMAN LPC

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	101YM0800X	Mental Health Counselor	2016044921	MO
2	101YP2500X	Professional Counselor	2016044921	MO
3	101Y00000X	Counselor	91020	TX

General Provider Information

NPI Number	:	1780123133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELEXIS E. COLEMAN LPC

Provider Business Mailing Address
First Line	:	2667 BENNINGTON PL
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1604
Country	:	US
Telephone Number	:	314-699-0243
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 S UNIVERSITY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5737
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:

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

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	08/20/2025

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