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General NPI Number Information
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NPI Number | 1396472411
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Entity Type | Organization
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Legal Business Name | GULF COAST NEUROPSYCHOLOGY AND NEURO-REHABILITATION
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 1746 PASS RD
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City | BILOXI
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State | MS
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Zip | 39531-3330
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Country | US
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Telephone | 228-465-2524
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Fax | 228-248-0020
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Provider Business Mailing Address
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Address Line | 1746 PASS RD
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City | BILOXI
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State | MS
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Zip | 39531-3330
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Country | US
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Telephone | 228-465-2524
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Fax | 228-248-0020
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | RACHA FARES
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Credential | PSYD
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Telephone | 228-465-2524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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