Provider Demographics
NPI:1538278536
Name:COASTAL CENTER, LLC.
Entity Type:Organization
Organization Name:COASTAL CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-267-2113
Mailing Address - Street 1:125 W. CENTRAL AVE,
Mailing Address - Street 2:SUITE 290
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420
Mailing Address - Country:US
Mailing Address - Phone:541-267-2113
Mailing Address - Fax:541-267-5071
Practice Address - Street 1:125 CENTRAL AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2316
Practice Address - Country:US
Practice Address - Phone:541-267-2113
Practice Address - Fax:541-267-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLCSW638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty