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General NPI Number Information
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NPI Number | 1265040976
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Entity Type | Organization
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Legal Business Name | GULF COAST MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 10641 WHITTNGTON COURT
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City | LARGO
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State | FL
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Zip | 33773
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Country | US
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Telephone | 813-793-7407
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Fax | 313-789-1751
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Provider Business Mailing Address
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Address Line | 690 MAIN ST STE 1044
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-3551
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Country | US
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Telephone | 813-793-7407
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Fax | 313-789-1751
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Authorized Official
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Title or Position | OWNER
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Name | DORIT MORECRAFT
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Credential | MSN, PMHNP-BC
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Telephone | 813-793-7407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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