Provider Demographics
NPI:1073059788
Name:COLEMAN, SUSANNE TERRI (PHD, LMFT,)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:TERRI
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD, LMFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1701
Mailing Address - Country:US
Mailing Address - Phone:954-644-9331
Mailing Address - Fax:
Practice Address - Street 1:3455 NE 12TH TER STE 9
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4534
Practice Address - Country:US
Practice Address - Phone:954-644-9331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist