Provider Demographics
NPI:1275108581
Name:GOUGH, ELIZABETH (CADACII)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GOUGH
Suffix:
Gender:F
Credentials:CADACII
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ZEINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADACII
Mailing Address - Street 1:2566 SUNDAY SILENCE CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-9124
Mailing Address - Country:US
Mailing Address - Phone:513-275-8678
Mailing Address - Fax:
Practice Address - Street 1:2566 SUNDAY SILENCE CT
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-9124
Practice Address - Country:US
Practice Address - Phone:513-275-8678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-51225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)