Provider Demographics
NPI:1689783482
Name:HELTON, COLEMAN JEFF (LPC)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:JEFF
Last Name:HELTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-8427
Mailing Address - Country:US
Mailing Address - Phone:731-925-5054
Mailing Address - Fax:731-925-5699
Practice Address - Street 1:1410 PICKWICK ST S
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3519
Practice Address - Country:US
Practice Address - Phone:731-925-5054
Practice Address - Fax:731-925-5699
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1838101YP2500X, 101YM0800X
TNLPC 1838104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN573121000Medicaid