Provider Demographics
NPI:1013563360
Name:NORTH COAST PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:NORTH COAST PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TEREBECKIJ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:941-920-1744
Mailing Address - Street 1:24500 CENTER RIDGE RD
Mailing Address - Street 2:BLDG 4, SUITE 120
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5602
Mailing Address - Country:US
Mailing Address - Phone:440-899-1300
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD
Practice Address - Street 2:BLDG 4, SUITE 120
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5602
Practice Address - Country:US
Practice Address - Phone:440-899-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty