MEDICARE: ANGELA GOUGER LPC, BCN, SEP

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	101YP2500X	Professional Counselor	76547	TX

General Provider Information

NPI Number	:	1891451019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GOUGER LPC, BCN, SEP

Provider Business Mailing Address
First Line	:	8610 OAK LEDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5851
Country	:	US
Telephone Number	:	832-798-4209
Fax Number	:

Provider Business Practice Location Address
First Line	:	8610 OAK LEDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5851
Country	:	US
Telephone Number	:	832-798-4209
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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