Provider Demographics
NPI:1538529250
Name:GULF COAST PSYCHIATRY LLC
Entity type:Organization
Organization Name:GULF COAST PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SERA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-343-8373
Mailing Address - Street 1:273 AZALEA RD OFC PARK
Mailing Address - Street 2:STE. 302
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1970
Mailing Address - Country:US
Mailing Address - Phone:251-343-8373
Mailing Address - Fax:251-343-3565
Practice Address - Street 1:273 AZALEA RD OFC PARK
Practice Address - Street 2:STE. 302
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1970
Practice Address - Country:US
Practice Address - Phone:251-343-8373
Practice Address - Fax:251-343-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34215261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1497959100OtherTYPE 1 NPI