MEDICARE: MS. SIERRIA CHANNING COLEMAN LCPC

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	180.011623	IL

General Provider Information

NPI Number	:	1639528219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SIERRIA CHANNING COLEMAN LCPC

Provider Business Mailing Address
First Line	:	4744 S GREENWOOD AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1956
Country	:	US
Telephone Number	:	312-476-2692
Fax Number	:

Provider Business Practice Location Address
First Line	:	5112 S CORNELL AVE APT 3NW
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615
Country	:	US
Telephone Number	:	312-476-2692
Fax Number	:

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	05/23/2018

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