Provider Demographics
NPI:1629675350
Name:COLEMAN, MARY ALEXANDRA (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALEXANDRA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 B. PORTER RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206
Mailing Address - Country:US
Mailing Address - Phone:310-968-7266
Mailing Address - Fax:
Practice Address - Street 1:807 B. PORTER RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206
Practice Address - Country:US
Practice Address - Phone:310-968-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38035106H00000X
TNLMT0000001446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist