Provider Demographics
NPI:1497633051
Name:GOUGE, ANTHONY (PPS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GOUGE
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19055
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-0055
Mailing Address - Country:US
Mailing Address - Phone:916-821-4645
Mailing Address - Fax:
Practice Address - Street 1:4600 BLACKROCK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1250
Practice Address - Country:US
Practice Address - Phone:916-928-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220002073101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool