Organization
GULF COAST MENTAL HEALTH CENTER
Active
Organization
GULF COAST MENTAL HEALTH CENTER
Active
Parent organization
GULF COAST MENTAL HEALTH CENTER
Other names
gulf coast industries
Organization subpart
Yes
Provider details
NPI number
Legal business name
GULF COAST MENTAL HEALTH CENTER
Authorized official
DEBORA J STANOVICH (CREDENTIALS SPECIALIST)
(228) 863-1132
Entity
Organization
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
R13-1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770456
—
MS
Enumeration date
03/05/2010
Last updated
10/21/2019
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