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General NPI Number Information
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NPI Number | 1235740663
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Entity Type | Organization
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Legal Business Name | LOST COAST FAMILY THERAPY
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 780 7TH ST STE S
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City | ARCATA
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State | CA
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Zip | 95521-6319
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Country | US
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Telephone | 707-502-6564
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Fax |
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Provider Business Mailing Address
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Address Line | 780 7TH ST STE S
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City | ARCATA
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State | CA
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Zip | 95521-6319
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNIFER SCHOOLEY POWELL
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Credential | LMFT, BCBA
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Telephone | 707-502-6564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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