Healthcare Provider Details

I. General information

NPI: 1295098820
Provider Name (Legal Business Name): NIKITA RANAE GOUGH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKITA RANAE SNEED MA

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13524 RAILWAY DR STE G
OKLAHOMA CITY OK
73114-2258
US

IV. Provider business mailing address

13524 RAILWAY DR STE G
OKLAHOMA CITY OK
73114-2258
US

V. Phone/Fax

Practice location:
  • Phone: 405-633-0452
  • Fax:
Mailing address:
  • Phone: 405-633-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5647
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: