Provider Demographics
NPI:1851152557
Name:COASTAL COMMUNITY MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:COASTAL COMMUNITY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LACOUTURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-739-1756
Mailing Address - Street 1:32 HARBOUR POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-5384
Mailing Address - Country:US
Mailing Address - Phone:979-739-1724
Mailing Address - Fax:
Practice Address - Street 1:32 HARBOUR POINTE DR
Practice Address - Street 2:
Practice Address - City:LINCOLNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04849-5384
Practice Address - Country:US
Practice Address - Phone:979-739-1724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty