Healthcare Provider Details

I. General information

NPI: 1740465434
Provider Name (Legal Business Name): TRACEY LYNN COLEMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. TRACEY LYNN PHILLIPS

II. Dates (important events)

Enumeration Date: 01/01/2008
Last Update Date: 02/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 SHAKER DRIVE #307
BOWIE MD
21150
US

IV. Provider business mailing address

10422 SPENCER COURT
BOWIE MD
20721
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-7225
  • Fax:
Mailing address:
  • Phone: 443-547-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: