Provider Demographics
NPI:1780017244
Name:GULF COAST THERAPY CONNECTION, PLLC.
Entity Type:Organization
Organization Name:GULF COAST THERAPY CONNECTION, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGRIT
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOODHAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-298-4192
Mailing Address - Street 1:1789 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-3343
Mailing Address - Country:US
Mailing Address - Phone:813-298-4192
Mailing Address - Fax:
Practice Address - Street 1:1789 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-3343
Practice Address - Country:US
Practice Address - Phone:813-298-4192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19964000Medicaid
FLFV668ZOtherMEDICARE ID #