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Organization
COASTAL MOUNTAIN YOUTH ACADEMY
Active
Organization
COASTAL MOUNTAIN YOUTH ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY WHITE (EXECUTIVE PROGRAM DIRECTOR)
(949) 498-7042
Entity
Organization
Contact information
Practice address
33171 PASEO CERVEZA, SUITE 120, SAN JUAN CAPISTRANO, CA 92675-4870
(949) 498-7042
(949) 248-2870
Mailing address
33171 PASEO CERVEZA, SUITE 120, SAN JUAN CAPISTRANO, CA 92675-4870
(949) 498-7042
(949) 248-2870
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YS0200X
School Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
05/23/2012
Last updated
05/23/2012
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