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General NPI Number Information
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NPI Number | 1750004974
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Entity Type | Individual
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Provider Name | DEBBIE DIANE GOUGH APCC & MHCA
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Gender | Female
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 830 SE IRELAND ST
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City | OAK HARBOR
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State | WA
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Zip | 98277-5502
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Country | US
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Telephone | 360-679-7676
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Fax | 360-679-9239
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Provider Business Mailing Address
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Address Line | 8594 SANTA ROSA RD
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City | ATASCADERO
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State | CA
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Zip | 93422-4947
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Country | US
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Telephone | 805-835-1797
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC11298
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61311711
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License Number State | WA
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