# MEMORIAL HOSPITAL @ GULFPORT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Memorial Behavioral Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649685561
- **Authorized official:** MICHELLE E JOHNSON (OFFICE MANAGER)
- **Authorized official phone:** (228) 575-1970

## Contact information

- **Practice address:** 11150 HIGHWAY 49, GULFPORT, MS 39503-4110
- **Practice address phone:** (228) 575-1000
- **Practice address fax:** (228) 575-2002
- **Mailing address:** 11150 HIGHWAY 49, GULFPORT, MS 39503-4110
- **Mailing address phone:** (228) 575-1000
- **Mailing address fax:** (228) 575-2002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | C6816 | MS | Yes |

## Other

- **Enumeration date:** 06/30/2014
- **Last updated:** 06/30/2014