Provider Demographics
NPI:1578775268
Name:COLEMAN, HELENE (LMP)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SE LYNCH CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7277
Mailing Address - Country:US
Mailing Address - Phone:136-042-6072
Mailing Address - Fax:
Practice Address - Street 1:104 E D ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2122
Practice Address - Country:US
Practice Address - Phone:136-046-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 21976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist