Organization
GARY COLEMAN, PSY.D. & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY LEE COLEMAN PSY. D. (PSYCHOLOGIST)
(630) 907-1735
Entity
Organization
Contact information
Practice address
2114 DEERPATH RD, AURORA, IL 60506-7943
(630) 907-1735
Mailing address
2114 DEERPATH RD, AURORA, IL 60506-7943
(630) 907-1735
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-006641
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04523608
BLUE CROSS & BLUE SHIELD
IL
01
—
1407994049
NPI TYPE I
IL
Enumeration date
07/10/2008
Last updated
07/10/2008
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