Provider Demographics
NPI:1346404555
Name:COLEMAN, THOMAS R (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SOUTHWIND PL
Mailing Address - Street 2:STE A
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3122
Mailing Address - Country:US
Mailing Address - Phone:785-776-5858
Mailing Address - Fax:785-776-6152
Practice Address - Street 1:225 SOUTHWIND PL
Practice Address - Street 2:STE A
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3122
Practice Address - Country:US
Practice Address - Phone:785-776-5858
Practice Address - Fax:785-776-6152
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100238900AMedicaid
R30797Medicare UPIN
KS004349Medicare PIN