Provider Demographics
NPI:1619006855
Name:COLEMAN, LEE H (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:H
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 ARDEN RD
Mailing Address - Street 2:CALTECH MC 1-8
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4135
Mailing Address - Country:US
Mailing Address - Phone:626-555-5555
Mailing Address - Fax:
Practice Address - Street 1:1239 ARDEN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4135
Practice Address - Country:US
Practice Address - Phone:626-555-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical