Provider Demographics
NPI:1164195558
Name:COASTAL KIDS AUTISM TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:COASTAL KIDS AUTISM TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-805-9363
Mailing Address - Street 1:115 TIFFANY ST
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-1601
Mailing Address - Country:US
Mailing Address - Phone:903-805-9363
Mailing Address - Fax:
Practice Address - Street 1:115 TIFFANY ST
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1601
Practice Address - Country:US
Practice Address - Phone:903-805-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty