Coastal Mountain Youth Academy

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

COASTAL MOUNTAIN YOUTH ACADEMY

Practice address

33171 Paseo Cerveza
Suite 120
San Juan Capistrano, CA 92675-4870

Phone

(949) 498-7042

Fax

(949) 248-2870

NPI assigned

May 23, 2012

Organization subpart

No

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

Authorized official

Name

Kelley White

Title

Executive Program Director

Phone

(949) 498-7042

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337731200000",
    "number": "1801156831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33171 PASEO CERVEZA",
            "address_2": "SUITE 120",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926754870",
            "telephone_number": "949-498-7042",
            "fax_number": "949-248-2870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33171 PASEO CERVEZA",
            "address_2": "SUITE 120",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926754870",
            "telephone_number": "949-498-7042",
            "fax_number": "949-248-2870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MOUNTAIN YOUTH ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-23",
        "last_updated": "2012-05-23",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "EXECUTIVE PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "949-498-7042"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emily Coe
• Joann Coker, FNP
• Mia Collica, M.S., MFTI
• Grant Collins, MSOM, LAC

• Mental Health Counselor in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; 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.