| Costa Clinical Psychology, Llc | |
|
625 Spruce St. # 7666 Brookings OR 97415 | |
| (541) 412-0700 | |
| (541) 412-0711 |
| Full Name | Costa Clinical Psychology, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 625 Spruce St., Brookings, Oregon |
| Authorized Official Name and Position | Teresa Ione Costa (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5414120700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Costa Clinical Psychology, Llc 625 Spruce St. P.o. Box 7666 Brookings OR 97415 Ph: (541) 412-0700 | Costa Clinical Psychology, Llc 625 Spruce St. # 7666 Brookings OR 97415 Ph: (541) 412-0700 |
| NPI Number | 1881144178 |
|---|---|
| Provider Enumeration Date | 10/11/2016 |
| Last Update Date | 10/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881144178 | NPI | - | NPPES |
| 500659667 | Medicaid | OR | |
| R16961 | Other | OR | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2356 (Oregon) | Primary |
| 1041C0700X | Social Worker - Clinical | L6298 (Oregon) | Secondary |
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