Provider Demographics
NPI:1700229986
Name:COLEMAN, MAY NOELLE
Entity Type:Individual
Prefix:MS
First Name:MAY
Middle Name:NOELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAY
Other - Middle Name:NOELLE
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21243
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1243
Mailing Address - Country:US
Mailing Address - Phone:505-715-3977
Mailing Address - Fax:
Practice Address - Street 1:2612 TEXAS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4684
Practice Address - Country:US
Practice Address - Phone:505-830-1871
Practice Address - Fax:505-830-0040
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87833581Medicaid