Provider Demographics
NPI:1558535625
Name:EMERALD COAST PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:EMERALD COAST PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-496-5689
Mailing Address - Street 1:4742 AMHURST CIR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5766
Mailing Address - Country:US
Mailing Address - Phone:850-496-5689
Mailing Address - Fax:
Practice Address - Street 1:4742 AMHURST CIR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5766
Practice Address - Country:US
Practice Address - Phone:850-496-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty