Provider Demographics
NPI:1063150126
Name:COLEMAN, CHLOE (CSW-I)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12427 S PASTURE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5608
Mailing Address - Country:US
Mailing Address - Phone:801-208-8838
Mailing Address - Fax:
Practice Address - Street 1:12427 S PASTURE RD STE 102
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-5608
Practice Address - Country:US
Practice Address - Phone:801-208-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12853373-3506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health