Provider Demographics
NPI:1851431480
Name:COLEMAN, FAY (IMFT)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 VILLAGIO DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5527
Mailing Address - Country:US
Mailing Address - Phone:916-284-8964
Mailing Address - Fax:
Practice Address - Street 1:8912 VOLUNTEER LN STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3224
Practice Address - Country:US
Practice Address - Phone:916-368-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist