Healthcare Provider Details

I. General information

NPI: 1730870544
Provider Name (Legal Business Name): GULF COAST INTEGRATIVE HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GOVERNMENT ST
OCEAN SPRINGS MS
39564-3931
US

IV. Provider business mailing address

37283 SWAMP RD STE 803
PRAIRIEVILLE LA
70769-3329
US

V. Phone/Fax

Practice location:
  • Phone: 225-254-9589
  • Fax: 225-208-7267
Mailing address:
  • Phone: 225-254-9589
  • Fax: 225-208-7267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CRISTY STIBAL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 208-821-1032