Provider Demographics
NPI:1154860534
Name:CENTRAL COAST BEHAVIOR SOLUTIONS
Entity Type:Organization
Organization Name:CENTRAL COAST BEHAVIOR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEADRICK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:559-707-4161
Mailing Address - Street 1:2339 HOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-9128
Mailing Address - Country:US
Mailing Address - Phone:805-242-4490
Mailing Address - Fax:
Practice Address - Street 1:2339 HOLDEN AVE
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445-9128
Practice Address - Country:US
Practice Address - Phone:805-242-4490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency