Healthcare Provider Details

I. General information

NPI: 1508992454
Provider Name (Legal Business Name): GULF COAST TEACHING FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/03/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 CM FEGAN DRIVE STE 3B/4B
HAMMOND LA
70403
US

IV. Provider business mailing address

2400 EDENBORN AVE
METAIRIE LA
70001-1817
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-1191
  • Fax: 985-345-9910
Mailing address:
  • Phone: 504-831-6561
  • Fax: 504-835-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberRC6597
License Number StateLA

VIII. Authorized Official

Name: MR. WILLIE GREEN
Title or Position: CEO
Credential: MPA
Phone: 504-831-6561