Healthcare Provider Details

I. General information

NPI: 1962191270
Provider Name (Legal Business Name): COASTAL WELLNESS AND LIFE COACHING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 SUNTREE BLVD STE 103A
MELBOURNE FL
32940-7540
US

IV. Provider business mailing address

3270 SUNTREE BLVD STE 103A
MELBOURNE FL
32940-7540
US

V. Phone/Fax

Practice location:
  • Phone: 321-757-4015
  • Fax: 321-363-8073
Mailing address:
  • Phone: 321-757-4015
  • Fax: 321-363-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NEELEY RENEE HUGHEY
Title or Position: OWNER
Credential:
Phone: 321-757-4015