Provider Demographics
NPI:1548928096
Name:COLEMAN, ANTHONY LEON (LSW)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEON
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 COUNTY ROAD 15 LOT 200
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9664
Mailing Address - Country:US
Mailing Address - Phone:574-226-2810
Mailing Address - Fax:
Practice Address - Street 1:1201 COUNTY ROAD 15 LOT 200
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9664
Practice Address - Country:US
Practice Address - Phone:574-226-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010298A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical