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Contact Information

COSTA CLINICAL PSYCHOLOGY, LLC
625 SPRUCE ST.
# 7666
BROOKINGS, OR97415
 Phone: 541-412-0700
 Fax: 541-412-0711
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for COSTA CLINICAL PSYCHOLOGY LLC · (Female)

NPI Number 1881144178
Status Active
Credentials
Entity Individual
Enumeration date 10/11/2016
Last updated 10/11/2016 - About 10 years ago
Sole proprietor 1 Not specified
Identifiers
  • OR License # 2356
  • OR License # L6298
  • OR Medicaid 500659667
  • OR Other R16961 MEDICARE PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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