Provider Demographics
NPI:1225418155
Name:RICHARD NIKLA LMHC DBA WEST COAST BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:RICHARD NIKLA LMHC DBA WEST COAST BEHAVIORAL THERAPY
Other - Org Name:WEST COAST BEHAVIORAL THEREAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HARBESON
Authorized Official - Last Name:NIKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, CAP, ICADC
Authorized Official - Phone:941-780-6939
Mailing Address - Street 1:5441 RIVERBLUFF CIR # V85
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5025
Mailing Address - Country:US
Mailing Address - Phone:941-780-6939
Mailing Address - Fax:941-953-1399
Practice Address - Street 1:2100 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4146
Practice Address - Country:US
Practice Address - Phone:941-780-6939
Practice Address - Fax:941-953-1399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD NIKLA, LMHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003673000Medicaid