=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174897409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIDIA NICOLE COLEMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2012
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 ELDRIDGE RD STE E
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-3794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-817-1238
-----------------------------------------------------
Fax | 281-869-3693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 ELDRIDGE RD STE E
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-3794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-907-9528
-----------------------------------------------------
Fax | 281-869-3693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 90602
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------