Coastal Therapy Group

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

COASTAL THERAPY GROUP

Practice address

167 Bluffton Rd Ste I
Bluffton, SC 29910-6250

Phone

(908) 295-4855

NPI assigned

Aug 17, 2023

Last updated

Aug 17, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jaclyn Mathisen, LPC

Title

Owner

Phone

(908) 295-4855

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1245013648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 DEERFIELD RD",
            "city": "HILTON HEAD ISLAND",
            "state": "SC",
            "postal_code": "299261935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 BLUFFTON RD STE I",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299106250",
            "telephone_number": "908-295-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL THERAPY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "MATHISEN",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-295-4855",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Bluffton, SC
• Providers in Bluffton, SC by specialty
• Mental Health Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.