Provider Demographics
NPI:1083771380
Name:SEBASTIAN, COLLEEN ANN (MC, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:ANN
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-0597
Mailing Address - Country:US
Mailing Address - Phone:805-779-0903
Mailing Address - Fax:
Practice Address - Street 1:1303 E GRAND AVE STE 115E
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2461
Practice Address - Country:US
Practice Address - Phone:805-779-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43194106H00000X
CALMFT43194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist