Provider Demographics
NPI:1053718940
Name:COLEMAN, JAN ELIZABETH (MFT-I)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:ELIZABETH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:ELIZABETH
Other - Last Name:MEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 10 BOX 1229
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09142-0013
Mailing Address - Country:US
Mailing Address - Phone:702-812-6311
Mailing Address - Fax:
Practice Address - Street 1:16 BLUMENSTRASSE
Practice Address - Street 2:
Practice Address - City:OTTERBERG
Practice Address - State:OTTERBERG
Practice Address - Zip Code:67697
Practice Address - Country:DE
Practice Address - Phone:702-812-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI3072106H00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst