Provider Demographics
NPI:1992256168
Name:COLEMAN, TIMOTHY (LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11999 KATY FWY STE 490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1608
Mailing Address - Country:US
Mailing Address - Phone:713-365-0700
Mailing Address - Fax:713-827-1080
Practice Address - Street 1:11999 KATY FWY STE 490
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1608
Practice Address - Country:US
Practice Address - Phone:713-365-0700
Practice Address - Fax:713-827-1080
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX71826OtherLPC