Organization
GULF COAST REHABILITATION SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA ELLIOTT SHANNON SAP,CAP,CEAP,LMHC (CEO)
(877) 957-3422
Entity
Organization
Contact information
Practice address
3825 HENDERSON BLVD, SUITE 405, TAMPA, FL 33629-5037
(877) 957-3422
(877) 957-3422
Mailing address
PO BOX 13798, TAMPA, FL 33681-3798
(877) 957-3422
(877) 957-3422
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
MH11189
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
5525
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
5552
FL
101YM0800X
Mental Health Counselor
MH11189
FL
101YP2500X
Professional Counselor
Primary
MH11189
FL
101YP2500X
Professional Counselor
SW7468
FL
102L00000X
Psychoanalyst
MH11189
FL
102L00000X
Psychoanalyst
SW7468
FL
103K00000X
Behavior Analyst
SW7468
FL
104100000X
Social Worker
SW7468
FL
1041C0700X
Clinical Social Worker
SW7468
FL
Other
Enumeration date
09/28/2010
Last updated
03/19/2014
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