Healthcare Provider Details

I. General information

NPI: 1730405614
Provider Name (Legal Business Name): COLEMAN PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OLIVE ST SUITE 405
AKRON OH
44310-3165
US

IV. Provider business mailing address

5982 RHODES RD
KENT OH
44240-4128
US

V. Phone/Fax

Practice location:
  • Phone: 330-541-7876
  • Fax: 330-678-3677
Mailing address:
  • Phone: 330-673-1347
  • Fax: 330-678-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0227
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0227
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0227
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0227
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0227
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0227
License Number StateOH
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0227
License Number StateOH

VIII. Authorized Official

Name: MR. BEN DABBS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 330-676-6850