Healthcare Provider Details

I. General information

NPI: 1447755079
Provider Name (Legal Business Name): EASTON THOMAS COLEMAN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 S CIRCLE DR
COLORADO SPRINGS CO
80906-4113
US

IV. Provider business mailing address

1431 W PIKES PEAK AVE
COLORADO SPRINGS CO
80904-4046
US

V. Phone/Fax

Practice location:
  • Phone: 207-570-9625
  • Fax:
Mailing address:
  • Phone: 207-570-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002389
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016260
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: