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NPI Code Detail

MEDICARE: DESIREE NICOLE COLEMAN MED

MEDICARE: DESIREE NICOLE COLEMAN MED
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1568805521
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREE NICOLE COLEMAN MED
Provider Business Mailing Address
First Line : 379 19TH ST
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97477-5006
Country : US
Telephone Number : 541-747-1235
Fax Number :
Provider Business Practice Location Address
First Line : 37875 JASPER LOWELL RD
Second Line :
City : JASPER
State : OR
Zip : 97438-9751
Country : US
Telephone Number : 541-747-1235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2013
Last Update Date : 04/09/2013

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Directions to “ DESIREE NICOLE COLEMAN MED” Practice Location

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