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Organization
KEZIA E COLEMAN PSYD LLC
Active
Organization
KEZIA E COLEMAN PSYD LLC
Active
Other names
Kezia E Coleman PsyD LLC, Healing Spaces Psychological Services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEZIA JACKSON PSYD (OWNER)
(314) 472-3091
Entity
Organization
Contact information
Practice address
7777 BONHOMME AVE STE 1800, CLAYTON, MO 63105-1931
(314) 472-3091
Mailing address
7711 BONHOMME AVE STE 720, CLAYTON, MO 63105-1908
(314) 472-3091
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346600061
—
MO
05
—
1790233153
—
MO
05
—
1992030027
—
MO
Enumeration date
06/16/2020
Last updated
09/21/2023
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