Provider Demographics
NPI:1437520418
Name:COASTAL SYNERGY ASSOCIATES
Entity type:Organization
Organization Name:COASTAL SYNERGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HISAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-867-1059
Mailing Address - Street 1:14646 COMPASS ST STE 10
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6232
Mailing Address - Country:US
Mailing Address - Phone:361-867-1059
Mailing Address - Fax:361-687-2563
Practice Address - Street 1:14646 COMPASS ST STE 10
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418
Practice Address - Country:US
Practice Address - Phone:361-852-0988
Practice Address - Fax:361-687-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty