Active NPI
Kimetta Arniece Coleman
- Pastoral Counselor
- Phoenix, AZ
National Provider Identifier
1114530540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- Practice address
- 2375 E Camelback Rd # 628
Phoenix, AZ 85016-3424 - Phone
- (602) 606-5742
- Fax
- (602) 801-2770
- NPI assigned
- Aug 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | AZ | Primary |
Addresses
Primary practice location
2375 E Camelback Rd # 628
Phoenix, AZ 85016-3424
Mailing address
PO Box 20712
Phoenix, AZ 85036-0712
Phone (602) 606-5742
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005311 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Journey Solutions Inc. | Current | Accepting new patients | |
| Journey Solutions Inc. | Pastoral | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Addiction (Substance Use Disorder) Counselor
- Phoenix, AZ
- NPI 1487227070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598313600000",
"number": "1114530540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20712",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850360712",
"telephone_number": "602-606-5742",
"fax_number": "602-801-2770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2375 E CAMELBACK RD # 628",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850163424",
"telephone_number": "602-606-5742",
"fax_number": "602-801-2770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEMAN",
"first_name": "KIMETTA",
"middle_name": "ARNIECE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-25",
"last_updated": "2020-08-25",
"certification_date": "2020-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "AZ",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "005311",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.