Healthcare Provider Details

I. General information

NPI: 1043103187
Provider Name (Legal Business Name): KRIZIA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NW FRANKLIN AVE STE 228
BEND OR
97703-2892
US

IV. Provider business mailing address

550 NW FRANKLIN AVE STE 228
BEND OR
97703-2892
US

V. Phone/Fax

Practice location:
  • Phone: 541-516-6330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: