Provider Demographics
NPI:1518622125
Name:GOULD, OLETHA HOPE (LMHC)
Entity Type:Individual
Prefix:
First Name:OLETHA
Middle Name:HOPE
Last Name:GOULD
Suffix:
Gender:F
Credentials:LMHC
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 7818
Mailing Address - Street 2:
Mailing Address - City:NEWCOMB
Mailing Address - State:NM
Mailing Address - Zip Code:87455-7818
Mailing Address - Country:US
Mailing Address - Phone:505-707-9718
Mailing Address - Fax:
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-327-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0221191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health