Provider Demographics
NPI:1083313399
Name:COLEMAN, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WOODLANDS DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-7702
Mailing Address - Country:US
Mailing Address - Phone:737-465-9647
Mailing Address - Fax:
Practice Address - Street 1:2801 WOODLANDS DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-7702
Practice Address - Country:US
Practice Address - Phone:737-465-9647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion
No171W00000XOther Service ProvidersContractor
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No374U00000XNursing Service Related ProvidersHome Health Aide