Provider Demographics
NPI:1114181971
Name:GARY COLEMAN, PSY.D. & ASSOCIATES
Entity Type:Organization
Organization Name:GARY COLEMAN, PSY.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:630-907-1735
Mailing Address - Street 1:2114 DEERPATH RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-7943
Mailing Address - Country:US
Mailing Address - Phone:630-907-1735
Mailing Address - Fax:
Practice Address - Street 1:2114 DEERPATH RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-7943
Practice Address - Country:US
Practice Address - Phone:630-907-1735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04523608OtherBLUE CROSS & BLUE SHIELD
IL1407994049OtherNPI TYPE I
IL215410Medicare PIN