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General NPI Number Information
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NPI Number | 1649070871
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST PSYCHOTHERAPY SERVICES, INC.
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 599 HIGUERA ST # F-1
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3851
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Country | US
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Telephone | 805-936-0140
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Fax |
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Provider Business Mailing Address
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Address Line | 219 VIA LA PAZ
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6962
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Country | US
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Telephone | 714-679-6194
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ADARE TORAL BRUINGTON
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Credential | LPCC
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Telephone | 805-936-0140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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