Provider Demographics
NPI:1902055338
Name:HARMS-COLEMAN, MINDY (LCPC)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:HARMS-COLEMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 TANGLEWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3111
Mailing Address - Country:US
Mailing Address - Phone:618-363-2150
Mailing Address - Fax:
Practice Address - Street 1:4933 BENCHMARK CENTRE DR STE E
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8927
Practice Address - Country:US
Practice Address - Phone:618-363-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018987101YP2500X
IL180012007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional