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General NPI Number Information
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NPI Number | 1588234256
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Entity Type | Individual
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Provider Name | COURTNEY GOUGH LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 630 PLAZA DR STE 101
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-2379
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Country | US
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Telephone | 720-577-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 E MISSISSIPPI AVE APT 18-101
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City | DENVER
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State | CO
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Zip | 80224-3185
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Country | US
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Telephone | 559-840-5027
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW.0009923310
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License Number State | CO
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