Provider Demographics
NPI:1902259823
Name:COASTAL CENTER FOR COLLABORATIVE HEALTH
Entity Type:Organization
Organization Name:COASTAL CENTER FOR COLLABORATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMISCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-557-1892
Mailing Address - Street 1:PO BOX 2298
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-2298
Mailing Address - Country:US
Mailing Address - Phone:805-570-4160
Mailing Address - Fax:
Practice Address - Street 1:923 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4503
Practice Address - Country:US
Practice Address - Phone:541-557-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1160251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health