| Coastal Center, Llc. | |
|
125 Central Ave Suite 290 Coos Bay OR 97420-2316 | |
| (541) 267-2113 | |
| (541) 267-5071 |
| Full Name | Coastal Center, Llc. |
|---|---|
| Speciality | Counselor |
| Location | 125 Central Ave, Coos Bay, Oregon |
| Authorized Official Name and Position | Jeremy Howell (MEMBER) |
| Authorized Official Contact | 5412672113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Center, Llc. 125 W. Central Ave, Suite 290 Coos Bay OR 97420 Ph: (541) 267-2113 | Coastal Center, Llc. 125 Central Ave Suite 290 Coos Bay OR 97420-2316 Ph: (541) 267-2113 |
| NPI Number | 1538278536 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8426046707 |
|---|---|
| Medicare Enrollment ID | O20040505000154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538278536 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LCSW638 (Oregon) | Primary |
| Provider Name | Deborah K Kirby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235260431 PECOS PAC ID: 3678547049 Enrollment ID: I20040823000116 |
| Provider Name | Harold Durel Kirby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487785697 PECOS PAC ID: 7810957511 Enrollment ID: I20041018000262 |
| Provider Name | Stephen Krajcir |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356494629 PECOS PAC ID: 5890745681 Enrollment ID: I20050201000225 |
| Provider Name | Denise E Stuntzner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245271246 PECOS PAC ID: 1052314523 Enrollment ID: I20060901000163 |
| Provider Name | Jeremy Howell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417088626 PECOS PAC ID: 3173586740 Enrollment ID: I20101228000718 |
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