Provider Demographics
NPI:1528006335
Name:COLEMAN, LISA LEE (LSCSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RED BRIDGE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4035
Mailing Address - Country:US
Mailing Address - Phone:816-868-3819
Mailing Address - Fax:816-941-2797
Practice Address - Street 1:400 E RED BRIDGE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4035
Practice Address - Country:US
Practice Address - Phone:816-868-3819
Practice Address - Fax:816-941-2797
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010023551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495005209Medicaid
7242793OtherAETNA
28051038OtherBCBS