Provider Demographics
NPI:1720161763
Name:GULF COAST COUNSELING SERVICES OF BAY COUNTY
Entity type:Organization
Organization Name:GULF COAST COUNSELING SERVICES OF BAY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-832-9364
Mailing Address - Street 1:PO BOX 16693
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-6693
Mailing Address - Country:US
Mailing Address - Phone:850-832-9364
Mailing Address - Fax:850-722-8782
Practice Address - Street 1:5409 NEHI RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-3043
Practice Address - Country:US
Practice Address - Phone:850-832-9364
Practice Address - Fax:850-722-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ035ROtherBCBS OF FLORIDA
FLZ035ROtherBCBS OF FLORIDA
FL=========OtherTRICARE