Healthcare Provider Details

I. General information

NPI: 1689783482
Provider Name (Legal Business Name): COLEMAN JEFF HELTON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 PICKWICK ST S
SAVANNAH TN
38372-3519
US

IV. Provider business mailing address

1109 BRIARWOOD DR
IUKA MS
38852-8427
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-5054
  • Fax: 731-925-5699
Mailing address:
  • Phone: 731-925-5054
  • Fax: 731-925-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC1838
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLPC 1838
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC1838
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: