Healthcare Provider Details

I. General information

NPI: 1982637633
Provider Name (Legal Business Name): COLEMAN PROFESSIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5982 RHODES RD
KENT OH
44240-4128
US

IV. Provider business mailing address

5982 RHODES RD
KENT OH
44240-4128
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0227
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0227
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0227
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0227
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0227
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0227
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0227
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0227
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0227
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0227
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0227
License Number StateOH

VIII. Authorized Official

Name: MRS. DIANA KEATHLEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 330-676-6826