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General NPI Number Information
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NPI Number | 1295788867
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Entity Type | Individual
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Provider Name | TIMOTHY D. GOULD ED.D LPC
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 903 S KINGSHIGHWAY ST
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City | SIKESTON
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State | MO
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Zip | 63801-4415
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Country | US
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Telephone | 573-979-3676
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Fax |
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Provider Business Mailing Address
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Address Line | 903 S KINGSHIGHWAY ST
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City | SIKESTON
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State | MO
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Zip | 63801-4415
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Country | US
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Telephone | 573-979-3676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002646
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CS002646
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License Number State | MO
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