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General NPI Number Information
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NPI Number | 1588662621
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Entity Type | Individual
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Provider Name | JOHN ROBERT GOULD PHD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1801 N LAMAR BLVD SUITE 210
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City | AUSTIN
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State | TX
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Zip | 78701-1051
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Country | US
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Telephone | 512-499-8674
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Fax | 512-499-0846
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Provider Business Mailing Address
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Address Line | 10217 BROOMFLOWER DR
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City | AUSTIN
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State | TX
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Zip | 78739-1447
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Country | US
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Telephone | 512-576-5052
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Fax | 512-301-0196
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 25094
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License Number State | TX
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