GULF COAST MENTAL HEALTH CENTER (NPI# 1861715773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861715773 |
| Entity Type | Organization |
| Organization Name | GULF COAST MENTAL HEALTH CENTER |
| Other Organization Name | GULF COAST INDUSTRIES |
| Practice Address |
1600 Broad Ave Gulfport MS 39501-3603 |
| Practice Telephone | 2288631132 |
| Practice Fax Number | 2288651700 |
| Mailing Telephone | 2288631132 |
| Mailing Fax Number | 2288651700 |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2019-10-21 |
| Authorized Official Name | DEBORA J STANOVICH (CREDENTIALS SPECIALIST) |
| Authorized Official Telephone | 2288631132 |
| Is Organization Subpart | Y |
| Parent Organization Name | GULF COAST MENTAL HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TM1800X |
Psychologist Specialization: Mental Retardation & Developmental Disabilities |
R13-1 | MS | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00770456 | 05 |
| Other Name | Type Code |
|---|---|
| gulf coast industries | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1124520549 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 819b Central Ave, Bay St Louis, MS 39520-3913 | 2018-03-01 |
| 1598127771 | Gulf Coast Mental Health Center | Psychologist | 1110 42nd Ave, Gulfport, MS 39501-2663 | 2016-03-25 |
| 1417934175 | Gulf Coast Mental Health Center | Psychologist | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2005-12-23 |
| 1962995860 | Gulf Coast Mental Health Center | Community/Behavioral Health | 15094 County Barn Road, Gulfport, MS 39503 | 2018-06-14 |
| 1548765670 | Gulf Coast Mental Health Center | Physical Therapist | 1600 Broad Avenue, Gulfport, MS 39501 | 2018-03-29 |
| 1467956037 | Gulf Coast Mental Health Center | Community/Behavioral Health | 1600 Broad Avenue, Gulfport, MS 39501-3603 | 2018-03-20 |
| 1821591728 | Gulf Coast Mental Health Center | Community/Behavioral Health | 1600 Broad Avenue, Gulfport, MS 39501-3603 | 2018-03-16 |
| 1649773540 | Gulf Coast Mental Health Center | Community/Behavioral Health | 1600 Broad Avenue, Gulfport, MS 39501-3603 | 2018-03-16 |
| 1386057628 | Gulf Coast Mental Health Center | Counselor | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2014-06-04 |
| Street Address |
1600 BROAD AVE |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501-3603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417934175 | Gulf Coast Mental Health Center | Psychologist | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2005-12-23 |
| 1043811839 | Kathy Ulland | Counselor | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-11-06 |
| 1508463357 | Nicole Brown | Counselor | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-10-05 |
| 1407453376 | Brian Weber | Counselor | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-10-05 |
| 1457958639 | Krysten Vagedes | Registered Nurse | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-10-01 |
| 1184239436 | Yeinil Guzman | Counselor | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-09-14 |
| 1972117216 | Nicole Hymel | Counselor | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-09-03 |
| 1053921668 | Dana Alexis Mixon | Counselor | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-08-07 |
| 1801405964 | Elizabeth Moran | Peer Specialist | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-07-24 |
| 1013526177 | June Boudreaux | Peer Specialist | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2020-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 103TM1800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Mental Retardation & Developmental Disabilities |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598127771 | Gulf Coast Mental Health Center | Psychologist | 1110 42nd Ave, Gulfport, MS 39501-2663 | 2016-03-25 |
| 1417934175 | Gulf Coast Mental Health Center | Psychologist | 1600 Broad Ave, Gulfport, MS 39501-3603 | 2005-12-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306178694 | Region 8 Mh/mr Commission | Psychologist | 613 Marquette Road, Brandon, MS 39042 | 2010-02-11 |
| 1326138025 | Aleshia Moffett | Psychologist | 3407 Shamrock Court, Gautier, MS 39553 | 2006-10-13 |
| 1952491664 | Rosemary M Bishop | Psychologist | 57 Industrial Park Road, Lucedale, MS 39452 | 2006-10-13 |
Please comment or provide details below to improve the information on GULF COAST MENTAL HEALTH CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.