Provider Demographics
NPI:1356858658
Name:COLEMAN, JANNA (MED, LPC-S, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MED, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 COUNTY ROAD 401
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8274
Mailing Address - Country:US
Mailing Address - Phone:662-416-1509
Mailing Address - Fax:
Practice Address - Street 1:507 HERITAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5571
Practice Address - Country:US
Practice Address - Phone:662-481-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional