Provider Demographics
NPI:1144605288
Name:CENTRAL COAST TRSTMENT CENTER
Entity Type:Organization
Organization Name:CENTRAL COAST TRSTMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:I
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-801-1299
Mailing Address - Street 1:201 S MILLER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5248
Mailing Address - Country:US
Mailing Address - Phone:805-801-1299
Mailing Address - Fax:
Practice Address - Street 1:201 S MILLER ST STE 104
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5248
Practice Address - Country:US
Practice Address - Phone:805-801-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health