Provider Demographics
NPI:1558018424
Name:COASTAL MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:COASTAL MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-347-6387
Mailing Address - Street 1:665 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4004
Mailing Address - Country:US
Mailing Address - Phone:800-614-4124
Mailing Address - Fax:888-217-4124
Practice Address - Street 1:360 CENTRAL AVE STE 800
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3984
Practice Address - Country:US
Practice Address - Phone:800-614-4124
Practice Address - Fax:888-217-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health