Provider Demographics
NPI:1518695030
Name:PACIFIC COAST THERAPIST INC
Entity Type:Organization
Organization Name:PACIFIC COAST THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:FRANK-RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:408-617-8994
Mailing Address - Street 1:17600 PACIFIC HWY UNIT 319
Mailing Address - Street 2:
Mailing Address - City:MARYLHURST
Mailing Address - State:OR
Mailing Address - Zip Code:97036-0800
Mailing Address - Country:US
Mailing Address - Phone:408-617-8994
Mailing Address - Fax:
Practice Address - Street 1:19785 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2228
Practice Address - Country:US
Practice Address - Phone:408-805-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty