Healthcare Provider Details

I. General information

NPI: 1154860534
Provider Name (Legal Business Name): CENTRAL COAST BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 HOLDEN AVE
OCEANO CA
93445-9128
US

IV. Provider business mailing address

2339 HOLDEN AVE
OCEANO CA
93445-9128
US

V. Phone/Fax

Practice location:
  • Phone: 805-242-4490
  • Fax:
Mailing address:
  • Phone: 805-242-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM D HEADRICK
Title or Position: CO-DIRECTOR
Credential: BCBA
Phone: 559-707-4161