| Gulf Coast Social Services, Inc. | |
|
700 Pujo St Ste A Lake Charles LA 70601-4378 | |
| (337) 436-6622 | |
| (337) 436-4403 |
| Full Name | Gulf Coast Social Services, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 700 Pujo St Ste A, Lake Charles, Louisiana |
| Authorized Official Name and Position | Willie Green (CEO) |
| Authorized Official Contact | 5048316561 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Social Services, Inc. 2400 Edenborn Ave Metairie LA 70001-1817 Ph: (504) 831-6561 | Gulf Coast Social Services, Inc. 700 Pujo St Ste A Lake Charles LA 70601-4378 Ph: (337) 436-6622 |
| NPI Number | 1891822631 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 09/29/2022 |
| Certification Date | 09/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891822631 | NPI | - | NPPES |
| 1172634 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 11762 (Louisiana) | Primary |
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