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General NPI Number Information
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NPI Number | 1538828181
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Entity Type | Organization
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Legal Business Name | COASTAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 7040 SEMINOLE PRATT WHITNEY RD # 25-141
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-5714
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Country | US
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Telephone | 561-461-0113
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Fax |
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Provider Business Mailing Address
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Address Line | 7040 SEMINOLE PRATT WHITNEY RD # 25-141
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-5714
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Country | US
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Telephone | 561-461-0113
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER/CLINICAL DIRECTOR
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Name | JOSIE RHOADS
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Credential | LCSW
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Telephone | 561-461-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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