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Organization
GULF COAST MENTAL HEALTH CENTER
Active
Organization
GULF COAST MENTAL HEALTH CENTER
Active
Other names
GULF COAST MENTAL HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MARY E JONES CPA (CFO)
(228) 863-1132
Entity
Organization
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
REG13-SO-01
MS
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
R-13-1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018213
—
MS
01
—
C00120
CENTER MEDICARE ID
MS
01
—
QMP000005325798
MOLINA MEDICAID
MS
Enumeration date
12/23/2005
Last updated
09/21/2020
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