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General NPI Number Information
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NPI Number | 1164195558
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Entity Type | Organization
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Legal Business Name | COASTAL KIDS AUTISM TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 116 MEDICAL DR
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City | PALESTINE
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State | TX
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Zip | 75801-4780
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Country | US
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Telephone | 903-805-9363
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Fax | 903-221-8648
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Provider Business Mailing Address
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Address Line | 116 MEDICAL DR
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City | PALESTINE
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State | TX
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Zip | 75801-4780
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Country | US
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Telephone | 903-284-1294
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Fax | 903-221-8648
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Authorized Official
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Title or Position | PARTNER/MANAGER
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Name | MONETTE WOODS
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Credential | LPC
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Telephone | 903-284-1294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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