Provider Demographics
NPI:1396427399
Name:COASTAL WATERS COUNSELING SERVICES
Entity type:Organization
Organization Name:COASTAL WATERS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-305-8075
Mailing Address - Street 1:139 N MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3300
Mailing Address - Country:US
Mailing Address - Phone:262-305-8075
Mailing Address - Fax:262-353-3777
Practice Address - Street 1:139 N MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3300
Practice Address - Country:US
Practice Address - Phone:262-305-8075
Practice Address - Fax:262-353-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty