Provider Demographics
NPI:1629237623
Name:COLEMAN, ARTELIA A (MA, CPC)
Entity Type:Individual
Prefix:MS
First Name:ARTELIA
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, CPC
Other - Prefix:MS
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CPC
Mailing Address - Street 1:3455 EAGLE BEND ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-4741
Mailing Address - Country:US
Mailing Address - Phone:314-783-6399
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD STE 77
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1910
Practice Address - Country:US
Practice Address - Phone:314-783-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030215101YP2500X
NVCP0163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional