MEDICARE: DARRYLL ANTHONY 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	106S00000X	Behavior Technician	9371009143	IN

General Provider Information

NPI Number	:	1538016589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRYLL ANTHONY COLEMAN

Provider Business Mailing Address
First Line	:	830 FLOYD ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-2945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 FLOYD ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-2945
Country	:	US
Telephone Number	:	219-308-7602
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “ DARRYLL ANTHONY COLEMAN ” Practice Location

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