NPIMap

Organization Active NPI

Gulf Coast Neuropsychology, LLC

  • Clinical Neuropsychologist
  • Gulfport, MS
National Provider Identifier
1194028555
Registry record updated Dec 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
45-725 Issued in MS
Legal business name
GULF COAST NEUROPSYCHOLOGY, LLC
Practice address
16195C Landon Rd
Gulfport, MS 39503-4121
Phone
(228) 385-7733
NPI assigned
Dec 7, 2010
Last updated
Dec 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Debra Sue Weitzel, PH.D.
Title
Owner
Phone
(228) 385-7733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X 45-725 MS Primary

Addresses

Primary practice location

16195C Landon Rd
Gulfport, MS 39503-4121

Mailing address

45 Hardy Court Ctr
#113
Gulfport, MS 39507-2501
Phone (228) 385-7733

National Provider Directory

National Provider Directory

Locations

16195C Landon Rd
Gulfport, MS 39503
Phone (228) 385-7733

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291680000000",
    "number": "1194028555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 HARDY COURT CTR",
            "address_2": "#113",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395072501",
            "telephone_number": "228-385-7733",
            "fax_number": "228-539-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16195C LANDON RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034121",
            "telephone_number": "228-385-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST NEUROPSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-07",
        "last_updated": "2010-12-07",
        "status": "A",
        "authorized_official_last_name": "WEITZEL",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-385-7733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "MS",
            "license": "45-725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.