Organization
GULF COAST PLAY THERAPY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INFANTA CHANTEL WHITE ED.S., LPC, NCC, RPT (OWNER)
(228) 697-7280
Entity
Organization
Contact information
Practice address
370 COURTHOUSE RD STE 102, GULFPORT, MS 39507-1889
(228) 224-2258
(228) 896-1155
Mailing address
370 COURTHOUSE RD STE 102, GULFPORT, MS 39507-1889
(228) 224-2258
(228) 896-1155
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2104
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225560410
—
MS
05
—
1427580612
—
MS
Enumeration date
03/28/2017
Last updated
07/21/2022
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