Provider Demographics
NPI:1457924631
Name:COLMAN, MARVIN (LAC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:COLMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 N LAST CHANCE GULCH
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0700
Mailing Address - Country:US
Mailing Address - Phone:406-422-4828
Mailing Address - Fax:
Practice Address - Street 1:1824 N LAST CHANCE GULCH
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0700
Practice Address - Country:US
Practice Address - Phone:406-422-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT82-2453659101YA0400X
MTBBH-LAC-LIC-49001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)