Provider Demographics
NPI:1528351087
Name:COLEMAN, JESSICA BRITTAIN (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BRITTAIN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 GOLDEN OAKS LOOP W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9010
Mailing Address - Country:US
Mailing Address - Phone:662-228-0095
Mailing Address - Fax:678-868-2843
Practice Address - Street 1:7075 GOLDEN OAKS LOOP W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9010
Practice Address - Country:US
Practice Address - Phone:622-228-0095
Practice Address - Fax:678-868-2843
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN097390142103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst