National Provider Identifier Database

COSTA CLINICAL PSYCHOLOGY LLC
Clinical

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth — one that is broadly inclusive of severe psychopathology — and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.


Contact Information

COSTA CLINICAL PSYCHOLOGY, LLC
625 SPRUCE ST.
# 7666
BROOKINGS, OR97415
Phone: 541-412-0700
Fax: 541-412-0711
Website:
Specialty Taxonomy Code
* Clinical 103TC0700X
Clinical 1041C0700X

* Indicates primary specialty

NPI Profile & details for COSTA CLINICAL PSYCHOLOGY, LLC

NPI Number 1881144178
Legal business name
LBN
COSTA CLINICAL PSYCHOLOGY, LLC
Authorized official TERESA COSTA - (CLINICAL PSYCHOLOGIST)
Entity Organization
Organization subpart No
Enumeration date 10/11/2016
Last updated 10/11/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • OR License #: 2356
  • OR License #: L6298
  • OR Medicaid: 500659667
  • OR Other: R16961 MEDICARE PTAN

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.

Reviews for COSTA CLINICAL PSYCHOLOGY, LLC

There are currently no reviews for COSTA CLINICAL PSYCHOLOGY, LLC


NPIdb - Home
v2.201