Organization
COAST TO COAST PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BAHRA LCSW (CEO)
(805) 875-5000
Entity
Organization
Contact information
Practice address
15497 W SAND ST, VICTORVILLE, CA 92392-2910
(760) 875-5000
(442) 327-9315
Mailing address
15497 W SAND ST, VICTORVILLE, CA 92392-2910
(442) 327-9311
(442) 327-9315
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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