=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326185844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL TREATMENT SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14730 NE 8TH ST SUITE 110
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98007-4116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-646-4406
-----------------------------------------------------
Fax | 425-646-4409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 52648
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98015-2648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-646-4406
-----------------------------------------------------
Fax | 425-646-4409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARGARET FERRIS
-----------------------------------------------------
Credential | C.D.P.
-----------------------------------------------------
Telephone | 425-646-4406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 17072100
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------