Provider Demographics
NPI:1265040976
Name:GULF COAST MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:GULF COAST MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORECRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:813-793-7407
Mailing Address - Street 1:690 MAIN ST STE 1044
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3551
Mailing Address - Country:US
Mailing Address - Phone:813-793-7407
Mailing Address - Fax:313-789-1751
Practice Address - Street 1:10641 WHITTNGTON COURT
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:813-793-7407
Practice Address - Fax:313-789-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center