Provider Demographics
NPI:1376775783
Name:COLEMAN, REBECCA LOIS (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOIS
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LOIS
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1300 W LYNN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3978
Mailing Address - Country:US
Mailing Address - Phone:512-322-9697
Mailing Address - Fax:512-322-9697
Practice Address - Street 1:1300 W LYNN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3978
Practice Address - Country:US
Practice Address - Phone:512-322-9697
Practice Address - Fax:512-322-9697
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical