MEDICARE: COREY 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	101YP1600X	Pastoral Counselor		NV
2	106H00000X	Marriage & Family Therapist	MI4480	NV

General Provider Information

NPI Number	:	1295690352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY COLEMAN

Provider Business Mailing Address
First Line	:	8545 W WARM SPRINGS RD STE A4-253
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8335 W CAMERO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-4541
Country	:	US
Telephone Number	:	702-423-4577
Fax Number	:

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

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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Directions to “ COREY COLEMAN ” Practice Location

Language	Start Address	Practice Location

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