Organization
COASTLINE BEHAVIORAL HEALTH
Active
Parent organization
COASTLINE RECOVERY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COASTLINE RECOVERY LLC
Authorized official
MIKE PRIESING MHW CATC (FOUNDER)
(949) 300-1657
Entity
Organization
Contact information
Practice address
2102 BUSINESS CENTER DR # 121, IRVINE, CA 92612-1001
(949) 300-1657
Mailing address
2102 BUSINESS CENTER DR # 121, IRVINE, CA 92612-1001
(949) 300-1657
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
300630AP
CA
101YM0800X
Mental Health Counselor
300630AP
CA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
300630AP
CA
103TP2701X
Group Psychotherapy Psychologist
300630AP
CA
1041C0700X
Clinical Social Worker
300630AP
CA
363LF0000X
Family Nurse Practitioner
14445
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
14445
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300630AP
DEPARTMENT OF HEALTHCARE SERVICES
CA
Enumeration date
02/26/2016
Last updated
02/26/2016
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