Provider Demographics
NPI:1770838567
Name:COLEMAN, ANGELA RENEE (BHRS)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RENEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-1643
Mailing Address - Country:US
Mailing Address - Phone:405-481-0448
Mailing Address - Fax:
Practice Address - Street 1:628 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4814
Practice Address - Country:US
Practice Address - Phone:405-626-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst