Provider Demographics
NPI:1528287828
Name:COLEMAN, TERRY LAVALLE (LMHC)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LAVALLE
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98046-1895
Mailing Address - Country:US
Mailing Address - Phone:206-719-4920
Mailing Address - Fax:
Practice Address - Street 1:5300 172ND ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3024
Practice Address - Country:US
Practice Address - Phone:206-719-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health