Provider Demographics
NPI:1467434399
Name:GULF BEND MENTAL HEALTH MENTAL RETARDATION CENTER
Entity Type:Organization
Organization Name:GULF BEND MENTAL HEALTH MENTAL RETARDATION CENTER
Other - Org Name:GULF BEND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-575-0611
Mailing Address - Street 1:6502 NURSERY DR. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904
Mailing Address - Country:US
Mailing Address - Phone:361-575-0611
Mailing Address - Fax:361-579-6913
Practice Address - Street 1:6502 NURSERY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1178
Practice Address - Country:US
Practice Address - Phone:361-575-0611
Practice Address - Fax:361-575-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135254407Medicaid
TX135254407Medicaid