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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

NPI Number 1881144178
LBN Legal business name COSTA CLINICAL PSYCHOLOGY, LLC
Authorized official TERESA COSTA - (CLINICAL PSYCHOLOGIST)
Entity Organization
Organization subpart 1 No
Enumeration date 10/11/2016
Last updated 10/11/2016 - About 10 years ago
Identifiers
OR License # 2356
OR License # L6298
OR Medicaid 500659667
OR Other R16961 MEDICARE PTAN
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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