MEDICARE: COLEMAN PROFESSIONAL SERVICES

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	101YP2500X	Professional Counselor	0227	OH
2	103T00000X	Psychologist	0227	OH
3	103TC1900X	Counseling Psychologist	0227	OH
4	104100000X	Social Worker	0227	OH
5	1041C0700X	Clinical Social Worker	0227	OH
6	163WP0808X	Psychiatric/Mental Health Registered Nurse	0227	OH
7	164W00000X	Licensed Practical Nurse	0227	OH
8	171M00000X	Case Manager/Care Coordinator	0227	OH
9	2084P0800X	Psychiatry Physician	0227	OH
10	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0227	OH
11	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	0227	OH
12	101YM0800X	Mental Health Counselor	0227	OH

General Provider Information

NPI Number	:	1215230669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLEMAN PROFESSIONAL SERVICES

Provider Business Mailing Address
First Line	:	5982 RHODES RD
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-4128
Country	:	US
Telephone Number	:	330-673-1347
Fax Number	:	330-678-3677

Provider Business Practice Location Address
First Line	:	799 S MAIN ST
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-1519
Country	:	US
Telephone Number	:	419-229-2222
Fax Number	:	419-229-2227

Authorized Official
Title or Position	:	CFO
Name	:	MR. BEN DABBS
Credential	:	CPA
Telephone Number	:	330-676-6850

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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Directions to “COLEMAN PROFESSIONAL SERVICES ” Practice Location

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