Healthcare Provider Details

I. General information

NPI: 1215776059
Provider Name (Legal Business Name): COASTAL PINELLAS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 DOUGLAS AVE
DUNEDIN FL
34698-7605
US

IV. Provider business mailing address

537 DOUGLAS AVE
DUNEDIN FL
34698-7605
US

V. Phone/Fax

Practice location:
  • Phone: 727-666-0222
  • Fax:
Mailing address:
  • Phone: 727-666-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FELIX NWOKOLO
Title or Position: CEO
Credential: MD
Phone: 727-666-0222