Costa Clinical Psychology, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2356 Issued in OR

Legal business name

COSTA CLINICAL PSYCHOLOGY, LLC

Practice address

625 Spruce St.
# 7666
Brookings, OR 97415

Phone

(541) 412-0700

Fax

(541) 412-0711

NPI assigned

Oct 11, 2016

Last updated

Oct 11, 2016By 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

Dr. Teresa Ione Costa, PSYDNPI 1770894461

Title

Clinical Psychologist

Phone

(541) 412-0700

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Teresa I. Costa, PSYD Former legal business name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

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.

• Teresa Ione Costa, PSYD

  • Clinical Psychologist
  • Brookings, OR
  • NPI 1770894461
  Medicare reassignment Authorized official
• Jeanne A. Bisson, M.A. LMFT

  • Marriage & Family Therapist
  • Brookings, OR
  • NPI 1972634673
  NPD

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

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476144000000",
    "number": "1881144178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 SPRUCE ST.",
            "address_2": "P.O. BOX 7666",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "97415",
            "telephone_number": "541-412-0700",
            "fax_number": "541-412-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 SPRUCE ST.",
            "address_2": "# 7666",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "97415",
            "telephone_number": "541-412-0700",
            "fax_number": "541-412-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTA CLINICAL PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-11",
        "last_updated": "2016-10-11",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "IONE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "541-412-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2356",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6298",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R16961",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500659667",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teresa I. Costa, PSYD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cheryl Marie Collier, P.T.A.
• Columbacare Services
• Columbiacare Services
• Ashley Cook
• Diana Lacy Cooper, CHW
• Teresa Ione Costa, PSYD
• County of Curry Brookings Harbor School District 17C (Brookings Harbor School District 17C)
• Kellie Marie Creaser, DNP, PMHNP-BC, FNP-C
• Howard Nelson Croy, P.A.
• Curry Health District (Curry Medical Center (formerly Brookings Medical Center))

• Clinical Psychologist in Brookings, OR
• Providers in Brookings, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.