| Gulf Coast Industries | |
|
1110 42nd Ave Gulfport MS 39501-2663 | |
| (228) 868-2072 | |
| (228) 868-2091 |
| Full Name | Gulf Coast Industries |
|---|---|
| Speciality | Psychologist - Intellectual & Developmental Disabilities |
| Location | 1110 42nd Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Thomas Pritchard (C F O) |
| Authorized Official Contact | 2288631132 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Industries 1600 Broad Ave Gulfport MS 39501-3603 Ph: (228) 863-1132 | Gulf Coast Industries 1110 42nd Ave Gulfport MS 39501-2663 Ph: (228) 868-2072 |
| NPI Number | 1598127771 |
|---|---|
| Provider Enumeration Date | 03/25/2016 |
| Last Update Date | 03/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598127771 | NPI | - | NPPES |
| 00770456 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TM1800X | Psychologist - Intellectual & Developmental Disabilities | REG13-PVS-WAC-01 (Mississippi) | Primary |
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