Provider Demographics
NPI:1124564398
Name:COLEMAN, NANETTE CAROL (MA, MFT, LPCC, CPLC)
Entity Type:Individual
Prefix:MS
First Name:NANETTE
Middle Name:CAROL
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, MFT, LPCC, CPLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41362 W WALKER WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138
Mailing Address - Country:US
Mailing Address - Phone:310-283-0418
Mailing Address - Fax:520-759-3117
Practice Address - Street 1:4401 ATLANTIC AVE STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2264
Practice Address - Country:US
Practice Address - Phone:562-999-3220
Practice Address - Fax:520-759-3117
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT96289106H00000X
CAIMF96289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty