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NPI Code Detail

MEDICARE: RAVEN COLEMAN

MEDICARE: RAVEN 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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-18-56410OTHERBACB

General Provider Information

NPI Number : 1134683295
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN COLEMAN
Provider Business Mailing Address
First Line : 27777 INKSTER RD STE 100
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5312
Country : US
Telephone Number : 855-772-8847
Fax Number :
Provider Business Practice Location Address
First Line : 1301 CENTRAL EXPY S STE 230
Second Line :
City : ALLEN
State : TX
Zip : 75013-8122
Country : US
Telephone Number : 855-772-8847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2019
Last Update Date : 04/13/2026

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Directions to “ RAVEN COLEMAN ” Practice Location

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