Provider Demographics
NPI:1619586849
Name:COLEMAN, GARY ALLEN JR
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLEN
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MUSKINGUM AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4957
Mailing Address - Country:US
Mailing Address - Phone:740-651-3560
Mailing Address - Fax:
Practice Address - Street 1:217 MUSKINGUM AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4957
Practice Address - Country:US
Practice Address - Phone:740-651-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)