=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356858658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANNA COLEMAN M.ED., LPC-S, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2018
-----------------------------------------------------
Last Update Date | 08/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 HERITAGE DR STE 102
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-5571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-481-2725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 COUNTY ROAD 401
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-8274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-416-1509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2089
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------