Provider Demographics
NPI:1073313524
Name:COLEMAN, LEROY
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 CRANE RIDGE DR STE 150C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4982
Mailing Address - Country:US
Mailing Address - Phone:769-251-5550
Mailing Address - Fax:
Practice Address - Street 1:2803 OLD NORTH HILLS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-1630
Practice Address - Country:US
Practice Address - Phone:601-453-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional