Organization
GULF COAST NEUROPSYCHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBRA SUE WEITZEL PH.D. (OWNER)
(228) 385-7733
Entity
Organization
Contact information
Practice address
16195C LANDON RD, GULFPORT, MS 39503-4121
(228) 385-7733
Mailing address
45 HARDY COURT CTR, #113, GULFPORT, MS 39507-2501
(228) 385-7733
(228) 539-1464
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
45-725
MS
Other
Enumeration date
12/07/2010
Last updated
12/07/2010
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