Provider Demographics
NPI:1891420402
Name:COASTAL MINDS COUNSELING CENTER
Entity Type:Organization
Organization Name:COASTAL MINDS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MED
Authorized Official - Phone:858-735-6213
Mailing Address - Street 1:3 CORPORATE PLAZA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7954
Mailing Address - Country:US
Mailing Address - Phone:949-919-0428
Mailing Address - Fax:949-209-0332
Practice Address - Street 1:3 CORPORATE PLAZA DR STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7954
Practice Address - Country:US
Practice Address - Phone:949-919-0428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)