Provider Demographics
NPI:1275150419
Name:GOLDEN COAST PSYCHOLOGY CENTER
Entity Type:Organization
Organization Name:GOLDEN COAST PSYCHOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-323-3729
Mailing Address - Street 1:3151 AIRWAY AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4620
Mailing Address - Country:US
Mailing Address - Phone:951-323-3729
Mailing Address - Fax:949-377-3940
Practice Address - Street 1:3151 AIRWAY AVE STE A2
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4620
Practice Address - Country:US
Practice Address - Phone:951-323-3729
Practice Address - Fax:949-377-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-04
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health