Gulf Coast Clinical Assocaites LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

GULF COAST CLINICAL ASSOCAITES LLC

Practice address

1005 S Shepherd Dr Apt 617
Houston, TX 77019-3639

Phone

(832) 837-9556

NPI assigned

Jun 6, 2022

Organization subpart

No

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

Authorized official

Name

Kwang KimNPI 1093329021

Title

Owner/Proprietor

Phone

(832) 837-9556

Specialties & licenses 2

Addresses

Other names 1

• IN BALANCE PSYCHIATRY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kwang Hyun Kim, APN

  • Psychiatric/Mental Health Nurse Practitioner
  • Aurora, CO
  • NPI 1093329021

  TX

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1629707674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 S SHEPHERD DR APT 617",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770193639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 S SHEPHERD DR APT 617",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770193639",
            "telephone_number": "832-837-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST CLINICAL ASSOCAITES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "KWANG",
        "authorized_official_title_or_position": "OWNER/PROPRIETOR",
        "authorized_official_telephone_number": "832-837-9556"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IN BALANCE PSYCHIATRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Mental Health Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Adult Mental Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.