Healthcare Provider Details

I. General information

NPI: 1417861261
Provider Name (Legal Business Name): COASTAL BEHAVIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 8TH ST
HERMOSA BEACH CA
90254-4101
US

IV. Provider business mailing address

703 PIER AVE STE B230
HERMOSA BEACH CA
90254-3949
US

V. Phone/Fax

Practice location:
  • Phone: 303-229-0815
  • Fax:
Mailing address:
  • Phone: 303-229-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ERIN MARIE CONNELLY
Title or Position: OWNER
Credential: BCBA
Phone: 303-229-0815