Provider Demographics
NPI:1912767336
Name:GULF COAST BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:GULF COAST BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAGATA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:941-416-4338
Mailing Address - Street 1:4075 LAGOON TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-7646
Mailing Address - Country:US
Mailing Address - Phone:941-416-4338
Mailing Address - Fax:
Practice Address - Street 1:4075 LAGOON TER
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-7646
Practice Address - Country:US
Practice Address - Phone:941-416-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty