Provider Demographics
NPI:1790007763
Name:WEST COAST COUNCELING
Entity Type:Organization
Organization Name:WEST COAST COUNCELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:STANSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-490-4721
Mailing Address - Street 1:2272 PACIFIC AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-490-4721
Mailing Address - Fax:562-490-4735
Practice Address - Street 1:481 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2843
Practice Address - Country:US
Practice Address - Phone:562-424-6531
Practice Address - Fax:562-424-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215105796OtherMEDICAL