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NPI Code Detail

MEDICARE: DR. KIMBERLY JEAN MCGOUGH PH.D., LPC

MEDICARE: DR. KIMBERLY JEAN MCGOUGH PH.D., LPC
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
1101YP2500XProfessional Counselor70463TX

General Provider Information

NPI Number : 1790256634
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY JEAN MCGOUGH PH.D., LPC
Provider Business Mailing Address
First Line : 4423 NAVAJO ST
Second Line :
City : PASADENA
State : TX
Zip : 77504-3421
Country : US
Telephone Number : 832-499-2470
Fax Number :
Provider Business Practice Location Address
First Line : 6021 FAIRMONT PKWY STE 200
Second Line :
City : PASADENA
State : TX
Zip : 77505-4511
Country : US
Telephone Number : 832-499-2470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2018
Last Update Date : 12/17/2018

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