Provider Demographics
NPI:1194872382
Name:SOUTH COAST THERAPISTS, INC.
Entity type:Organization
Organization Name:SOUTH COAST THERAPISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MFCC
Authorized Official - Phone:714-899-4005
Mailing Address - Street 1:PO BOX 4166
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92605-4166
Mailing Address - Country:US
Mailing Address - Phone:714-899-4005
Mailing Address - Fax:714-899-4275
Practice Address - Street 1:16480 HARBOR BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1361
Practice Address - Country:US
Practice Address - Phone:714-899-4005
Practice Address - Fax:714-899-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14233101YM0800X
CAMFC12680101YM0800X
CAPSY12485101YM0800X
CAPSY9811101YM0800X
CAA63583101YM0800X
CAG47617101YM0800X
CAMFC39025101YM0800X
CAG28225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty