MEDICARE: MRS. ASHA L 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891201695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHA L COLEMAN

Provider Business Mailing Address
First Line	:	6110 SHALLOWFORD RD STE B
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1894
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 W 37TH ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37410-1207
Country	:	US
Telephone Number	:	423-825-7337
Fax Number	:

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

Provider Enumeration Date	:	12/17/2017
Last Update Date	:	12/17/2017

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