Provider Demographics
NPI:1922443506
Name:WEST COAST COUNSELING SERVICES INC DBA WEST COAST COUNSELING CENTER
Entity Type:Organization
Organization Name:WEST COAST COUNSELING SERVICES INC DBA WEST COAST COUNSELING CENTER
Other - Org Name:WEST C OAST HEALTHY LIVING INC DBA WEST COAST HEALTHY LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-424-6531
Mailing Address - Street 1:481 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2843
Mailing Address - Country:US
Mailing Address - Phone:562-424-6531
Mailing Address - Fax:
Practice Address - Street 1:2158 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4514
Practice Address - Country:US
Practice Address - Phone:562-424-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare