Coastal ABA, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

COASTAL ABA, LLC

Practice address

6001 41St Ave N
St Petersburg, FL 33709-5221

Phone

(727) 656-6045

Fax

(727) 656-6045

NPI assigned

Sep 23, 2017

Organization subpart

No

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

Authorized official

Name

Lauren Altman Brum, BCBA

Title

Owner, Behavior Analyst

Phone

(727) 888-3296

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1506124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506124800000",
    "number": "1851800726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3135 1ST AVE N, PO BOX 12844",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "33730",
            "telephone_number": "727-999-0583",
            "fax_number": "855-306-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 41ST AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337095221",
            "telephone_number": "727-656-6045",
            "fax_number": "727-656-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL ABA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-23",
        "last_updated": "2017-09-23",
        "status": "A",
        "authorized_official_last_name": "BRUM",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "ALTMAN",
        "authorized_official_title_or_position": "OWNER, BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "727-888-3296",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073972451",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700266871",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2017; 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.