Healthcare Provider Details

I. General information

NPI: 1104961580
Provider Name (Legal Business Name): ELAINNA COLEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST SUITE 200
WHEAT RIDGE CO
80033-6715
US

IV. Provider business mailing address

4851 INDEPENDENCE ST SUITE 200
WHEAT RIDGE CO
80033-6715
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5507
  • Fax: 303-432-5260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number667
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: