Healthcare Provider Details

I. General information

NPI: 1104206226
Provider Name (Legal Business Name): GULF COAST BEHAVIORAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 RODD FIELD RD
CORPUS CHRISTI TX
78414-3901
US

IV. Provider business mailing address

3126 RODD FIELD RD
CORPUS CHRISTI TX
78414-3901
US

V. Phone/Fax

Practice location:
  • Phone: 361-452-6898
  • Fax: 361-458-6870
Mailing address:
  • Phone: 361-452-6898
  • Fax: 361-452-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANA FALCON
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 956-358-2723