Provider Demographics
NPI:1225030703
Name:KOUGH, SHIELA (LMSW)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:
Last Name:KOUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LORRAINE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-5600
Mailing Address - Country:US
Mailing Address - Phone:620-663-7595
Mailing Address - Fax:620-663-5263
Practice Address - Street 1:760 W D AVE
Practice Address - Street 2:STE 1
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1266
Practice Address - Country:US
Practice Address - Phone:620-532-3895
Practice Address - Fax:620-532-3710
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE97013OtherBLUE CROSS BLUE SHIELD NE
NE100098120AMedicaid
NE97013OtherBLUE CROSS BLUE SHIELD NE