Healthcare Provider Details

I. General information

NPI: 1255907085
Provider Name (Legal Business Name): DAVID GOGUEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 N ARMENIA AVE STE 350
TAMPA FL
33607-6434
US

IV. Provider business mailing address

24459 PAINTER DR
LAND O LAKES FL
34639-5461
US

V. Phone/Fax

Practice location:
  • Phone: 813-212-8251
  • Fax:
Mailing address:
  • Phone: 813-748-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID GOGUEN
Title or Position: OWNER
Credential: LMHC
Phone: 813-748-2824