Provider Demographics
NPI:1447755079
Name:COLEMAN, EASTON THOMAS (MA)
Entity Type:Individual
Prefix:
First Name:EASTON
Middle Name:THOMAS
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 REDEMPTION PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-9503
Mailing Address - Country:US
Mailing Address - Phone:719-534-3976
Mailing Address - Fax:
Practice Address - Street 1:2751 WILDERNESS RD
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4719
Practice Address - Country:US
Practice Address - Phone:719-526-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016260101YM0800X
COACD.0002389101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health