| Gulf Coast Behavioral Clinic Llc | |
|
3126 Rodd Field Rd Corpus Christi TX 78414-3901 | |
| (361) 452-6898 | |
| (361) 458-6870 |
| Full Name | Gulf Coast Behavioral Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3126 Rodd Field Rd, Corpus Christi, Texas |
| Authorized Official Name and Position | Ana Falcon (BUSINESS DIRECTOR) |
| Authorized Official Contact | 9563582723 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Behavioral Clinic Llc 3126 Rodd Field Rd Corpus Christi TX 78414-3901 Ph: (361) 452-6898 | Gulf Coast Behavioral Clinic Llc 3126 Rodd Field Rd Corpus Christi TX 78414-3901 Ph: (361) 452-6898 |
| NPI Number | 1104206226 |
|---|---|
| Provider Enumeration Date | 06/03/2015 |
| Last Update Date | 10/08/2020 |
| Certification Date | 10/08/2020 |
| Medicare PECOS PAC ID | 5698080182 |
|---|---|
| Medicare Enrollment ID | O20150812008324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104206226 | NPI | - | NPPES |
| 351321001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mario A Quintanilla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871552729 PECOS PAC ID: 0244402303 Enrollment ID: I20111013000541 |
| Provider Name | John O Lusins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689846701 PECOS PAC ID: 8123290533 Enrollment ID: I20130815000785 |
| Provider Name | Hatira Watts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598130361 PECOS PAC ID: 0749583789 Enrollment ID: I20160125002149 |
| Provider Name | Georgina Chinwe Uzoigwe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518204924 PECOS PAC ID: 3678832300 Enrollment ID: I20180125001598 |
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