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NPI Code Detail

MEDICARE: CHRISTINA E GOULD L.C.S.W.

MEDICARE: CHRISTINA E GOULD L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker33857TX

General Provider Information

NPI Number : 1780612853
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA E GOULD L.C.S.W.
Provider Business Mailing Address
First Line : PO BOX 1729
Second Line :
City : BASTROP
State : TX
Zip : 78602-8729
Country : US
Telephone Number : 512-797-8242
Fax Number : 512-303-6416
Provider Business Practice Location Address
First Line : 909 PECAN ST
Second Line :
City : BASTROP
State : TX
Zip : 78602-3819
Country : US
Telephone Number : 512-797-8242
Fax Number : 512-303-6416
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 07/08/2007

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