MEDICARE: STEPHANIE PATRYCE COLEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	49518	CA

General Provider Information

NPI Number	:	1114556834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PATRYCE COLEMAN

Provider Business Mailing Address
First Line	:	3003 HOWARD ST
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6817
Country	:	US
Telephone Number	:	415-820-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 HOWARD ST
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6817
Country	:	US
Telephone Number	:	415-820-1512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2020
Last Update Date	:	04/17/2023

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