Healthcare Provider Details

I. General information

NPI: 1073791257
Provider Name (Legal Business Name): MISTY LYNN COLEMAN MSW,LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2008
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 S HIGH ST
COLUMBUS OH
43215-5602
US

IV. Provider business mailing address

31 W CHURCH ST
NEWARK OH
43055-5514
US

V. Phone/Fax

Practice location:
  • Phone: 614-227-9444
  • Fax: 614-227-9445
Mailing address:
  • Phone: 740-281-1777
  • Fax: 740-281-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0009371
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: