Provider Demographics
NPI:1255780797
Name:COLEMAN, KATHRYN ELIZABETH (LMSW)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:866-611-1512
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:1150 E SHERMAN BLVD STE 1175
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1885
Practice Address - Country:US
Practice Address - Phone:231-672-6740
Practice Address - Fax:231-672-6749
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010995511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical