| Coastal Therapy & Family Services | |
|
912 Convent Ave Pascagoula MS 39567-4334 | |
| (228) 990-3701 | |
| Not Available |
| Full Name | Coastal Therapy & Family Services |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 912 Convent Ave, Pascagoula, Mississippi |
| Authorized Official Name and Position | Randy Kirksey (OWNER) |
| Authorized Official Contact | 2289903701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Therapy & Family Services 912 Convent Ave Ste 4 Pascagoula MS 39567-4334 Ph: (228) 990-3701 | Coastal Therapy & Family Services 912 Convent Ave Pascagoula MS 39567-4334 Ph: (228) 990-3701 |
| NPI Number | 1780449132 |
|---|---|
| Provider Enumeration Date | 02/15/2024 |
| Last Update Date | 06/11/2024 |
| Certification Date | 06/11/2024 |
| Medicare PECOS PAC ID | 7315384856 |
|---|---|
| Medicare Enrollment ID | O20240320001657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780449132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Randy S Kirksey |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1518382266 PECOS PAC ID: 8224475769 Enrollment ID: I20240320001779 |
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