Provider Demographics
NPI:1609232677
Name:COLEMAN, LAURA (LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 PRAIRIE HEIGHTS DR
Mailing Address - Street 2:APT 104
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2217
Mailing Address - Country:US
Mailing Address - Phone:608-692-9926
Mailing Address - Fax:
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9188
Practice Address - Country:US
Practice Address - Phone:608-445-7490
Practice Address - Fax:608-424-9099
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI398-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist