Provider Demographics
NPI:1073264974
Name:GOULD, SHAUN (CDCA)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:GOULD
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9477
Mailing Address - Country:US
Mailing Address - Phone:937-544-4020
Mailing Address - Fax:937-544-4009
Practice Address - Street 1:3461 CROSS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697-9477
Practice Address - Country:US
Practice Address - Phone:937-544-4020
Practice Address - Fax:937-544-4009
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177075101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH177075OtherSUBSTANCE ABUSE