NPIMap

Organization Active NPI

Gulf Coast Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gulfport, MS
National Provider Identifier
1417934175
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GULF COAST MENTAL HEALTH CENTER
Doing business as
Gulf Coast Mental Health Center
Practice address
1600 Broad Ave
Gulfport, MS 39501-3603
Phone
(228) 863-1132
Fax
(228) 865-1700
NPI assigned
Dec 23, 2005
Last updated
Sep 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Authorized official

Name
Mary E Jones, CPA
Title
Cfo
Phone
(228) 863-1132

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual & Developmental Disabilities Psychologist 103TM1800X REG13-SO-01 MS
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X R-13-1 MS

Addresses

Primary practice location

1600 Broad Ave
Gulfport, MS 39501-3603

Mailing address

1600 Broad Ave
Gulfport, MS 39501-3603
Phone (228) 863-1132

Other identifiers 3

IdentifierTypeStateIssuer
00018213MedicaidMS
C00120OtherMSCENTER MEDICARE ID
QMP000005325798OtherMSMOLINA MEDICAID

Other names 1

  • GULF COAST MENTAL HEALTH CENTER Doing business as

National Provider Directory

National Provider Directory

Locations

819 Central Ave
Bay St Louis, MS 39520
Phone (228) 467-1118

15120 County Barn Rd
Gulfport, MS 39503
Phone (228) 213-3900

211 Highway 11 S
Picayune, MS 39466
Phone (601) 798-7001

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1417934175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395013603",
            "telephone_number": "228-863-1132",
            "fax_number": "228-865-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395013603",
            "telephone_number": "228-863-1132",
            "fax_number": "228-865-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "228-863-1132",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MS",
            "license": "REG13-SO-01",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MS",
            "license": "R-13-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00018213",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTER MEDICARE ID",
            "identifier": "C00120",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA MEDICAID",
            "identifier": "QMP000005325798",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GULF COAST MENTAL HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 21, 2020; 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.