Provider Demographics
NPI:1598530248
Name:PACIFIC COAST PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:PACIFIC COAST PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:253-234-7226
Mailing Address - Street 1:5326 SW MANNING ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3128
Mailing Address - Country:US
Mailing Address - Phone:253-234-7226
Mailing Address - Fax:
Practice Address - Street 1:3515 SW ALASKA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2730
Practice Address - Country:US
Practice Address - Phone:253-234-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical