Provider Demographics
NPI:1356104392
Name:COLEMAN, TANYA S (PLMHP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:S
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6010
Mailing Address - Country:US
Mailing Address - Phone:308-520-9347
Mailing Address - Fax:
Practice Address - Street 1:1002 E PHILIP AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6104
Practice Address - Country:US
Practice Address - Phone:308-532-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health