Provider Demographics
NPI:1841549698
Name:COLEMAN, ISAAC BERNARD JR
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:BERNARD
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N MIDWEST BLVD
Mailing Address - Street 2:APT 233
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4304
Mailing Address - Country:US
Mailing Address - Phone:405-520-3459
Mailing Address - Fax:
Practice Address - Street 1:317 N MIDWEST BLVD
Practice Address - Street 2:APT 233
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4304
Practice Address - Country:US
Practice Address - Phone:405-520-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor