Provider Demographics
NPI:1629006754
Name:COLEMAN, EDMOND (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTER FOR SEXUAL HEALTH
Mailing Address - Street 2:1300 SECOND AVE SOUTH, SUITE 180
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-1500
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR SEXUAL HEALTH
Practice Address - Street 2:1300 SECOND AVE SOUTH, SUITE 180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN806247100Medicaid
MN26G15COOtherBCBS
MNHP28737OtherHEALTHPARTNERS
MN1007665OtherPREFERRED ONE
MN61-94400OtherMEDICA CHOICE