| Gulf Coast Play Therapy Clinic, Llc | |
|
370 Courthouse Rd Ste 102 Gulfport MS 39507-1889 | |
| (228) 224-2258 | |
| (228) 896-1155 |
| Full Name | Gulf Coast Play Therapy Clinic, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 370 Courthouse Rd Ste 102, Gulfport, Mississippi |
| Authorized Official Name and Position | Infanta Chantel White (OWNER) |
| Authorized Official Contact | 2286977280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Play Therapy Clinic, Llc 370 Courthouse Rd Ste 102 Gulfport MS 39507-1889 Ph: (228) 224-2258 | Gulf Coast Play Therapy Clinic, Llc 370 Courthouse Rd Ste 102 Gulfport MS 39507-1889 Ph: (228) 224-2258 |
| NPI Number | 1225560410 |
|---|---|
| Provider Enumeration Date | 03/28/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225560410 | NPI | - | NPPES |
| 1427580612 | Medicaid | MS | |
| 1225560410 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2104 (Mississippi) | Primary |
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