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NPI Code Detail

MEDICARE: COASTAL COUNSELING SERVICES

MEDICARE: COASTAL COUNSELING SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1164011912
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL COUNSELING SERVICES
Provider Business Mailing Address
First Line : 314 SHUMWAY RD
Second Line :
City : CAMANO ISLAND
State : WA
Zip : 98282-8763
Country : US
Telephone Number : 208-661-7432
Fax Number : 360-873-8041
Provider Business Practice Location Address
First Line : 117 N 1ST ST STE 55
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-2858
Country : US
Telephone Number : 208-661-7432
Fax Number : 360-873-8041
Authorized Official
Title or Position : MENTAL HEALTH COUNSELOR
Name : RENE ARLENE KNOLES
Credential : LMHC
Telephone Number : 208-661-7432
Provider Enumeration Date : 01/15/2021
Last Update Date : 01/15/2021

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Directions to “COASTAL COUNSELING SERVICES ” Practice Location

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