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General NPI Number Information
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NPI Number | 1699150748
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST THERAPY CENTER
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 3319B MISSION DR
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1827
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Country | US
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Telephone | 831-392-7064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2674
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City | APTOS
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State | CA
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Zip | 95001-2674
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Country | US
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Telephone | 831-392-7064
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | NATHAN WEINSTEIN
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Credential | LMFT
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Telephone | 831-392-7064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 48570
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License Number State | CA
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