Doctor Name: | TAMRA L COLDREN |
NPI Number: | 1114919545 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149008366 |
Business Practice Address: | 103a South Pointe Drive Edwardsville, IL - 620253780 |
Business Phone Number: | 6186562000 |
Business Fax Number: | 6186561169 |
Mailing Address: | Po Box 790, EDWARDSVILLE |
State: | IL |
Postal Code: | 620250790 |
Phone Number: | 6186929640 |
Fax Number: | 6186929643 |
NPI Enumeration Date: | 08/22/2005 |
NPI Last Update Date: | 03/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149008366 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |