Organization Active NPI

Gulfside Healthcare Inc

  • Mental Health Counselor
  • Fort Myers, FL
National Provider Identifier
1861515801
Registry record updated Jan 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
GULFSIDE HEALTHCARE INC
Practice address
6361 Presidential CT Ste 105
Fort Myers, FL 33919-3583
Phone
(239) 470-6810
Fax
(239) 938-9912
NPI assigned
Apr 6, 2007
Last updated
Jan 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2019

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

Authorized official

Name
Mr. David E. Wood
Title
President
Phone
(239) 470-6810

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

6361 Presidential CT Ste 105
Fort Myers, FL 33919-3583

Mailing address

6361 Presidential CT Ste 105
Fort Myers, FL 33919-3583
Phone (239) 470-6810

Other practice location 1

3822 Broadway
Unit C
Fort Myers, FL 33901-8148
Phone (239) 938-9911

National Provider Directory

National Provider Directory

Locations

6361 Presidential Ct
Ste 105
Fort Myers, FL 33919
Phone (239) 470-6810

Practitioners & affiliated clinicians

Practitioners 1

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": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546819200000",
    "number": "1861515801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6361 PRESIDENTIAL CT STE 105",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193583",
            "telephone_number": "239-470-6810",
            "fax_number": "239-938-9912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6361 PRESIDENTIAL CT STE 105",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193583",
            "telephone_number": "239-470-6810",
            "fax_number": "239-938-9912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3822 Broadway",
            "address_2": "Unit C",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339018148",
            "country_code": "US",
            "telephone_number": "239-938-9911",
            "fax_number": "239-938-9912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GULFSIDE HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2019-01-07",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-470-6810",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; 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.