Provider Demographics
NPI:1821155078
Name:PACIFIC COAST CENTER FOR FAMILY COUNSELING & PERSONAL DEVELOPMENT, INC
Entity Type:Organization
Organization Name:PACIFIC COAST CENTER FOR FAMILY COUNSELING & PERSONAL DEVELOPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCHENRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD MFT
Authorized Official - Phone:805-654-1840
Mailing Address - Street 1:950 COUNTY SQUARE DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-654-1840
Mailing Address - Fax:800-244-7801
Practice Address - Street 1:950 COUNTY SQUARE DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-654-1840
Practice Address - Fax:800-244-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24549106H00000X
CAMFT56615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty