# COASTAL INTEGRATIVE WELLNESS, A MARRIAGE AND FAMILY CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477232932
- **Authorized official:** LEAH DEROSE LMFT (PRESIDENT)
- **Authorized official phone:** (805) 724-6831

## Contact information

- **Practice address:** 3889 LONG ST STE 200, SAN LUIS OBISPO, CA 93401-7581
- **Practice address phone:** (805) 724-6831
- **Mailing address:** 3889 LONG ST STE 200, SAN LUIS OBISPO, CA 93401-7581
- **Mailing address phone:** (805) 724-6831

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 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