Provider Demographics
NPI:1104206226
Name:GULF COAST BEHAVIORAL CLINIC LLC
Entity type:Organization
Organization Name:GULF COAST BEHAVIORAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-358-2723
Mailing Address - Street 1:3126 RODD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3901
Mailing Address - Country:US
Mailing Address - Phone:361-452-6898
Mailing Address - Fax:361-452-6870
Practice Address - Street 1:3126 RODD FIELD RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3901
Practice Address - Country:US
Practice Address - Phone:361-452-6898
Practice Address - Fax:361-458-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351321001Medicaid