Provider Demographics
NPI:1740796671
Name:COLEMAN, CYARA LANETTE (EDS, MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:CYARA
Middle Name:LANETTE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:EDS, MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-1454
Mailing Address - Country:US
Mailing Address - Phone:314-584-9912
Mailing Address - Fax:
Practice Address - Street 1:634 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3746
Practice Address - Country:US
Practice Address - Phone:314-584-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-15-06946106S00000X
1-21-51903103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILRBT-15-06946OtherRBT
WA61219373OtherLBA
1-21-51903OtherBCBA
ILBACB312357OtherRBT