Provider Demographics
NPI:1083127120
Name:GULF COAST THERAPY WORKS, LLC
Entity Type:Organization
Organization Name:GULF COAST THERAPY WORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC, RPT
Authorized Official - Phone:251-517-7737
Mailing Address - Street 1:PO BOX 1732
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-1732
Mailing Address - Country:US
Mailing Address - Phone:251-517-7737
Mailing Address - Fax:251-517-7720
Practice Address - Street 1:101 LOTTIE LN STE 3
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-517-7737
Practice Address - Fax:251-517-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-12
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10822101YM0800X
AL3221101YP2500X, 101YP2500X
ALMFT482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH10822OtherLICENSED MENTAL HEALTH COUNSELOR
1912256330OtherNPI
1568633436OtherNPI
AL3221OtherLICENSED PROFESSIONAL COUNSELOR
AL4133OtherLICENSED PROFESSIONAL COUNSELOR