Provider Demographics
NPI:1649070871
Name:CENTRAL COAST PSYCHOTHERAPY SERVICES, INC.
Entity type:Organization
Organization Name:CENTRAL COAST PSYCHOTHERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADARE
Authorized Official - Middle Name:TORAL
Authorized Official - Last Name:BRUINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:805-936-0140
Mailing Address - Street 1:219 VIA LA PAZ
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6962
Mailing Address - Country:US
Mailing Address - Phone:714-679-6194
Mailing Address - Fax:
Practice Address - Street 1:599 HIGUERA ST # F-1
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3851
Practice Address - Country:US
Practice Address - Phone:805-936-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty