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NPI Code Detail

MEDICARE: DEBORAH GOUGH LMSW

MEDICARE: DEBORAH GOUGH LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1316043862
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH GOUGH LMSW
Provider Business Mailing Address
First Line : 12851 GRAND RIVER RD
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-8506
Country : US
Telephone Number : 810-227-1211
Fax Number : 810-220-5509
Provider Business Practice Location Address
First Line : 12851 GRAND RIVER RD
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-8506
Country : US
Telephone Number : 810-227-1211
Fax Number : 810-220-5509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 05/09/2017

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