MEDICARE: MRS. KELLY MCGOUGAN MA, LPCA, NCC

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
1	101YM0800X	Mental Health Counselor		SC

General Provider Information

NPI Number	:	1487445516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY MCGOUGAN MA, LPCA, NCC

Provider Business Mailing Address
First Line	:	313 MATUSKOVIC DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-8213
Country	:	US
Telephone Number	:	386-290-0810
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 MATUSKOVIC DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-8213
Country	:	US
Telephone Number	:	386-290-0810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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