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General NPI Number Information
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NPI Number | 1558492090
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Entity Type | Organization
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Legal Business Name | COASTAL BEHAVIORAL THERAPY, INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 7145 TURNER RD STE 102
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City | ROCKLEDGE
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State | FL
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Zip | 32955-5723
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Country | US
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Telephone | 321-684-3334
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Fax | 321-635-9171
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Provider Business Mailing Address
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Address Line | 7145 TURNER RD STE 102
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City | ROCKLEDGE
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State | FL
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Zip | 32955-5723
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Country | US
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Telephone | 321-684-3334
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Fax | 321-635-9171
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ISIDRO ZAVALETA
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Credential | MS, BCBA
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Telephone | 321-684-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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