Provider Demographics
NPI:1114373123
Name:BETH DAVID COUNSELING SERVICES
Entity Type:Organization
Organization Name:BETH DAVID COUNSELING SERVICES
Other - Org Name:COASTAL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANCLINI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-598-0631
Mailing Address - Street 1:330 JAMES WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2878
Mailing Address - Country:US
Mailing Address - Phone:805-598-0631
Mailing Address - Fax:805-296-6178
Practice Address - Street 1:330 JAMES WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2878
Practice Address - Country:US
Practice Address - Phone:805-598-0631
Practice Address - Fax:805-296-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53907106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty