Provider Demographics
NPI:1861556896
Name:COLEMAN, JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 S CANYON TRL
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9415
Mailing Address - Country:US
Mailing Address - Phone:330-220-9312
Mailing Address - Fax:330-220-9312
Practice Address - Street 1:429 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1716
Practice Address - Country:US
Practice Address - Phone:330-220-9312
Practice Address - Fax:330-220-9312
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5047OtherOHIO LICENSE NUMBER