Provider Demographics
NPI:1699005181
Name:COLEMAN, KATHLEEN RUTH (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RUTH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 SE 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5409
Mailing Address - Country:US
Mailing Address - Phone:503-460-7638
Mailing Address - Fax:
Practice Address - Street 1:2505 SE 11TH AVE STE 238
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1062
Practice Address - Country:US
Practice Address - Phone:503-460-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional