Healthcare Provider Details

I. General information

NPI: 1467304329
Provider Name (Legal Business Name): COASTAL MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BEATLINE RD STE 3
LONG BEACH MS
39560-4138
US

IV. Provider business mailing address

4011 BEATLINE RD STE 3
LONG BEACH MS
39560-4138
US

V. Phone/Fax

Practice location:
  • Phone: 228-262-9886
  • Fax:
Mailing address:
  • Phone: 228-262-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUDITH OLSON
Title or Position: OWNER
Credential:
Phone: 228-262-9886