Healthcare Provider Details

I. General information

NPI: 1073000188
Provider Name (Legal Business Name): CHAD COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 VIRGINIA ST
PARIS TN
38242-5341
US

IV. Provider business mailing address

PO BOX 30
PARIS TN
38242-0030
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-0521
  • Fax: 731-642-1010
Mailing address:
  • Phone: 731-644-1753
  • Fax: 731-642-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0000004209
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: