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General NPI Number Information
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NPI Number | 1780408732
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Entity Type | Organization
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Legal Business Name | PACIFIC YOUTH COALITION
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 227 S HALCYON RD STE 101
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3174
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Country | US
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Telephone | 805-801-2231
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Fax | 805-335-6859
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Provider Business Mailing Address
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Address Line | 227 S HALCYON RD STE 101
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3174
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Country | US
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Telephone | 805-801-2231
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Fax | 805-335-6859
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Authorized Official
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Title or Position | VP OF THE BOARD
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Name | AMANDA BASSON
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Credential |
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Telephone | 805-801-2231
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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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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 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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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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