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Organization
COASTAL INTEGRATIVE WELLNESS, A MARRIAGE AND FAMILY CORP
Active
Organization
COASTAL INTEGRATIVE WELLNESS, A MARRIAGE AND FAMILY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH DEROSE LMFT (PRESIDENT)
(805) 724-6831
Entity
Organization
Contact information
Practice address
3889 LONG ST STE 200, SAN LUIS OBISPO, CA 93401-7581
(805) 724-6831
Mailing address
3889 LONG ST STE 200, SAN LUIS OBISPO, CA 93401-7581
(805) 724-6831
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
251B00000X
Case Management Agency
—
NULL
261Q00000X
Clinic/Center
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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