Provider Demographics
NPI:1043927759
Name:COLEMAN, BENJAMIN BRYAN (LPCC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BRYAN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 PINE RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-6845
Mailing Address - Country:US
Mailing Address - Phone:320-515-1609
Mailing Address - Fax:320-679-8183
Practice Address - Street 1:23 PINE ST N
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1320
Practice Address - Country:US
Practice Address - Phone:320-679-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health