Provider Demographics
NPI:1831886514
Name:GULFSIDE COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:GULFSIDE COUNSELING AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-261-3951
Mailing Address - Street 1:1101 GULF BREEZE PKW
Mailing Address - Street 2:BLDG 2, STE 4
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4891
Mailing Address - Country:US
Mailing Address - Phone:850-203-0045
Mailing Address - Fax:
Practice Address - Street 1:1101 GULF BREEZE PKW
Practice Address - Street 2:BLDG 2, STE 4
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4891
Practice Address - Country:US
Practice Address - Phone:850-203-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty