Provider Demographics
NPI:1134674484
Name:COLEMAN, TRACIE ELIZABETH (MHPP)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:ELIZABETH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ALDERSGATE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6676
Mailing Address - Country:US
Mailing Address - Phone:501-661-0720
Mailing Address - Fax:501-325-7938
Practice Address - Street 1:410 RIVER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4206
Practice Address - Country:US
Practice Address - Phone:501-776-5779
Practice Address - Fax:501-217-9757
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator