Healthcare Provider Details

I. General information

NPI: 1164011912
Provider Name (Legal Business Name): COASTAL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N 1ST ST STE 55
MOUNT VERNON WA
98273-2858
US

IV. Provider business mailing address

314 SHUMWAY RD
CAMANO ISLAND WA
98282-8763
US

V. Phone/Fax

Practice location:
  • Phone: 208-661-7432
  • Fax: 360-873-8041
Mailing address:
  • Phone: 208-661-7432
  • Fax: 360-873-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENE ARLENE KNOLES
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 208-661-7432