Coastal Center for Anxiety Treatment

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY20248 Issued in CA

Legal business name

COASTAL CENTER FOR ANXIETY TREATMENT

Practice address

1194 Pacific St Ste 101
Suite B-2
San Luis Obispo, CA 93401-3338

Phone

(805) 473-3388

Fax

(805) 548-0815

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Eric D Goodman, PHDNPI 1942270541

Title

Director

Phone

(805) 473-3388

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric David Goodman, PH.D.

  • Cognitive & Behavioral Psychologist
  • San Luis Obispo, CA
  • NPI 1942270541
  NPD (past) Authorized official

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371772800000",
    "number": "1306998786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1194 PACIFIC ST STE 101",
            "address_2": "SUITE B-2",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013338",
            "telephone_number": "805-473-3388",
            "fax_number": "805-548-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1194 PACIFIC ST STE 101",
            "address_2": "SUITE B-2",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013338",
            "telephone_number": "805-473-3388",
            "fax_number": "805-548-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CENTER FOR ANXIETY TREATMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-06-21",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "805-473-3388",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "PSY20248",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Coastal Concierge Medical Practioners, Inc
• Coastal Counseling Collective, Professional Clinical Counselor PC
• Coastal Family Dermatology, PC
• Coastal Family Dermatology, PC

• All providers in San Luis Obispo, CA
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; 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.