Healthcare Provider Details

I. General information

NPI: 1982901104
Provider Name (Legal Business Name): GULF COAST OPPORTUNITY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 SURREY ST
LAFAYETTE LA
70501-6142
US

IV. Provider business mailing address

4333 SHREVEPORT HWY
PINEVILLE LA
71360-3828
US

V. Phone/Fax

Practice location:
  • Phone: 337-654-5519
  • Fax:
Mailing address:
  • Phone: 318-445-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DONNA MCPHERSON
Title or Position: BOAD MEMBER
Credential:
Phone: 318-445-6470