Provider Demographics
NPI:1881348787
Name:COASTAL BEND BEHAVIORAL CLINIC
Entity type:Organization
Organization Name:COASTAL BEND BEHAVIORAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:MS
Authorized Official - First Name:HATIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:361-656-7869
Mailing Address - Street 1:1400 OCEAN DR
Mailing Address - Street 2:#1103A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2120
Mailing Address - Country:US
Mailing Address - Phone:361-658-7869
Mailing Address - Fax:
Practice Address - Street 1:1400 OCEAN DR
Practice Address - Street 2:#1103A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2120
Practice Address - Country:US
Practice Address - Phone:361-658-7869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty