# GULF COAST MENTAL HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548765670
- **Authorized official:** MANDY JO MCDONALD (BILLING SUPERVISOR)
- **Authorized official phone:** (228) 863-1132

## Contact information

- **Practice address:** 1600 BROAD AVENUE, GULFPORT, MS 39501
- **Practice address phone:** (228) 863-1132
- **Practice address fax:** (228) 865-1700
- **Mailing address:** 1600 BROAD AVENUE, GULFPORT, MS 39501
- **Mailing address phone:** (228) 863-1132
- **Mailing address fax:** (228) 865-1700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251S0007X | Sports Physical Therapist | M8456 | NULL | Yes |
| 2251S0007X | Sports Physical Therapist | M8456 | — | Yes |

## Other

- **Enumeration date:** 03/29/2018
- **Last updated:** 03/29/2018