Provider Demographics
NPI:1477441749
Name:KOUGL, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KOUGL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16108 RED CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3881
Mailing Address - Country:US
Mailing Address - Phone:214-876-0754
Mailing Address - Fax:
Practice Address - Street 1:16108 RED CLOVER CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3881
Practice Address - Country:US
Practice Address - Phone:214-876-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)