Healthcare Provider Details

I. General information

NPI: 1992093090
Provider Name (Legal Business Name): GULF COAST PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4167 CLARK RD
SARASOTA FL
34233-2403
US

IV. Provider business mailing address

4167 CLARK RD
SARASOTA FL
34233-2403
US

V. Phone/Fax

Practice location:
  • Phone: 941-219-3111
  • Fax:
Mailing address:
  • Phone: 941-219-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHEL L THORPE
Title or Position: PRESIDENT, CLINICAL DIRECTOR
Credential: LICSW
Phone: 941-219-3111