Basic Information
| Provider Information | |||||||||
| NPI: | 1902259823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL CENTER FOR COLLABORATIVE HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2298 | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973392298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055704160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 SW MADISON AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973334728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415571892 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | RAMISCH | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | LMFT, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5415571892 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | T1160 | OR | Y | Agencies | Community/Behavioral Health |
No ID Information.