Provider Demographics
NPI:1912588039
Name:OCEANVISTA COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:OCEANVISTA COUNSELING ASSOCIATES, LLC
Other - Org Name:OCEANVISTA COUNSELING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:386-569-4084
Mailing Address - Street 1:1275 W GRANADA BLVD STE 6A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8105
Mailing Address - Country:US
Mailing Address - Phone:386-449-8600
Mailing Address - Fax:833-559-1151
Practice Address - Street 1:1275 W GRANADA BLVD STE 6A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8105
Practice Address - Country:US
Practice Address - Phone:386-449-8600
Practice Address - Fax:833-559-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952921652OtherINDIVIDUAL NPI