Provider Demographics
NPI:1831650068
Name:COLEMAN, TAYLOR RENEE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:HIPPENSTEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:
Practice Address - Street 1:251 W 84TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6243
Practice Address - Country:US
Practice Address - Phone:219-205-3463
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-55759103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-21-55759OtherBACB CERTIFICATE