GULF COAST MENTAL HEALTH CENTER NPI 1417934175

NPI Information

NPI: 1417934175
Provider Name: GULF COAST MENTAL HEALTH CENTER

Doing Business As: GULF COAST MENTAL HEALTH CENTER

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1600 BROAD AVE
GULFPORT, MS
ZIP 39501
Phone: (228) 863-1132
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GULF COAST MENTAL HEALTH CENTER is a mental health (including community mental health center) clinic center in Gulfport, MS. GULF COAST MENTAL HEALTH CENTER NPI is 1417934175. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Gulf Coast Mental Health Center.

The provider's business location address is:

1600 BROAD AVE
GULFPORT, MS
ZIP 39501-603
Phone: (228) 863-1132
Fax: (228) 865-1700

The provider's authorized official is Mary E Jones .
The authorized official title is Cfo and has the following contact phone number (228) 863-1132.

The enumeration date for this NPI number is 12/23/2005 and was last updated on 9/21/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TM1800X	Psychologist	Intellectual and Developmental Disabilities	REG13-SO-01	MISSISSIPPI	No
2	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		R-13-1	MISSISSIPPI	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00018213	MEDICAID	MISSISSIPPI
2	C00120	OTHER	MISSISSIPPI	CENTER MEDICARE ID
3	QMP000005325798	OTHER	MISSISSIPPI	MOLINA MEDICAID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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