NPIMap

Organization Active NPI

Coastal Center for Cognitive Therapy, PA

  • Clinical Psychologist
  • Myrtle Beach, SC
National Provider Identifier
1447436290
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1071 Issued in SC
Legal business name
COASTAL CENTER FOR COGNITIVE THERAPY, PA
Practice address
1101 Johnson Ave
Suite 200
Myrtle Beach, SC 29577-1660
Phone
(843) 839-9028
Fax
(843) 839-9029
NPI assigned
Jan 10, 2008
Last updated
Mar 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

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

Authorized official

Name
Dr. Michael M. Grant, PH.D.
Title
President/Secretary
Phone
(843) 839-9028

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1071 SC Primary

Addresses

Primary practice location

1101 Johnson Ave
Suite 200
Myrtle Beach, SC 29577-1660

Mailing address

1101 Johnson Ave
Suite 200
Myrtle Beach, SC 29577-1660
Phone (843) 839-9028

National Provider Directory

National Provider Directory

Locations

1101 Johnson Ave
Ste 200
Myrtle Beach, SC 29577
Phone (843) 839-9028

3025 Newcastle Loop
Myrtle Beach, SC 29588
Phone (843) 215-1330

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1447436290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 JOHNSON AVE",
            "address_2": "SUITE 200",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295771660",
            "telephone_number": "843-839-9028",
            "fax_number": "843-839-9029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 JOHNSON AVE",
            "address_2": "SUITE 200",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295771660",
            "telephone_number": "843-839-9028",
            "fax_number": "843-839-9029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CENTER FOR COGNITIVE THERAPY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT/SECRETARY",
        "authorized_official_telephone_number": "843-839-9028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "1071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.