Healthcare Provider Details

I. General information

NPI: 1811138969
Provider Name (Legal Business Name): KELLY S. COLEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY S DEHAVEN LCSW

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 06/26/2023
Certification Date: 06/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W HAMPDEN AVE STE 350
ENGLEWOOD CO
80110-2233
US

IV. Provider business mailing address

1065 NE 125TH ST STE 409
NORTH MIAMI FL
33161-5834
US

V. Phone/Fax

Practice location:
  • Phone: 303-872-1734
  • Fax: 719-623-0165
Mailing address:
  • Phone: 888-852-6672
  • Fax: 786-235-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-1230
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: