Provider Demographics
NPI:1528150711
Name:CENTRAL COAST OUTPATIENT PROGRAM
Entity type:Organization
Organization Name:CENTRAL COAST OUTPATIENT PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER-UYEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-386-5849
Mailing Address - Street 1:16-643 KIPIMANA ST STE 20
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8002
Mailing Address - Country:US
Mailing Address - Phone:808-966-7453
Mailing Address - Fax:808-966-8990
Practice Address - Street 1:508 HIGUEROA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-688-5057
Practice Address - Fax:805-594-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50208106H00000X
CAMFC29341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA803421070OtherTAXID