MEDICARE: GULF COAST BEHAVIORAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1336447853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	13707 STATE HIGHWAY 249
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-2705
Country	:	US
Telephone Number	:	821-448-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	13707 STATE HIGHWAY 249
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-2705
Country	:	US
Telephone Number	:	821-448-2818
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MARY JEWEL WASHINGTON
Credential	:
Telephone Number	:	281-352-2006

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	03/08/2011

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