Provider Demographics
NPI:1710318456
Name:COLEMAN, ANGELO JR
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 BLACK OAKS ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2045
Mailing Address - Country:US
Mailing Address - Phone:702-370-7370
Mailing Address - Fax:
Practice Address - Street 1:3170 E SUNSET RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2755
Practice Address - Country:US
Practice Address - Phone:702-629-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst