Provider Demographics
NPI:1699559997
Name:COLEMAN, SHATTO BREONLEE SR (LPC)
Entity type:Individual
Prefix:
First Name:SHATTO
Middle Name:BREONLEE
Last Name:COLEMAN
Suffix:SR
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:SHATTO
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SHATTO B COLEMAN
Mailing Address - Street 1:PO BOX 451741
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-1741
Mailing Address - Country:US
Mailing Address - Phone:972-822-7129
Mailing Address - Fax:
Practice Address - Street 1:315 N THROCKMORTON AVE
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-2540
Practice Address - Country:US
Practice Address - Phone:972-822-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX92165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health