Healthcare Provider Details

I. General information

NPI: 1588521264
Provider Name (Legal Business Name): JAROD COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 LEXINGTON AVE
SPRINGFIELD OH
45505-2620
US

IV. Provider business mailing address

787 E MAIN ST
XENIA OH
45385-3251
US

V. Phone/Fax

Practice location:
  • Phone: 937-328-5300
  • Fax:
Mailing address:
  • Phone: 937-679-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.195113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: