Provider Demographics
NPI:1184095762
Name:COASTAL BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:COASTAL BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-271-3397
Mailing Address - Street 1:1650 NE 26TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1431
Mailing Address - Country:US
Mailing Address - Phone:954-271-3397
Mailing Address - Fax:954-947-3028
Practice Address - Street 1:1650 NE 26TH ST STE 201
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1431
Practice Address - Country:US
Practice Address - Phone:954-271-3397
Practice Address - Fax:954-947-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty