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NPI Code Detail

MEDICARE: RAVEN COLEMAN

MEDICARE: RAVEN 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
1103K00000XBehavior Analyst1-24-73706TX

General Provider Information

NPI Number : 1710722111
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN COLEMAN
Provider Business Mailing Address
First Line : 6914 BRISBANE CT STE 200
Second Line :
City : SUGAR LAND
State : TX
Zip : 77479-4924
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2051 GREENHOUSE RD STE 160
Second Line :
City : HOUSTON
State : TX
Zip : 77084-8022
Country : US
Telephone Number : 844-272-7223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2024
Last Update Date : 06/27/2024

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Directions to “ RAVEN COLEMAN ” Practice Location

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