Healthcare Provider Details

I. General information

NPI: 1346897808
Provider Name (Legal Business Name): ALLCOAST COMPREHENSIVE THERAPIES LICENSED CLINICAL SOCIAL WORKER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17595 ALMAHURST ST STE 100A
CITY OF INDUSTRY CA
91748-1792
US

IV. Provider business mailing address

17595 ALMAHURST ST STE 100A
CITY OF INDUSTRY CA
91748-1792
US

V. Phone/Fax

Practice location:
  • Phone: 714-720-7255
  • Fax:
Mailing address:
  • Phone: 714-720-7255
  • Fax: 626-965-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN ALINAS
Title or Position: PRESIDENT
Credential: LCSW
Phone: 714-720-7255