Healthcare Provider Details

I. General information

NPI: 1699112698
Provider Name (Legal Business Name): CENTRAL COAST BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 09/02/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 CAMINO MERCADO
ARROYO GRANDE CA
93420-1814
US

IV. Provider business mailing address

536 CAMINO MERCADO
ARROYO GRANDE CA
93420-1814
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-0279
  • Fax: 805-439-1070
Mailing address:
  • Phone: 805-540-0279
  • Fax: 805-439-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19126
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53324
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC52093
License Number StateCA

VIII. Authorized Official

Name: MR. JOSE FELIBERTI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 805-540-0279