Provider Demographics
NPI:1588234256
Name:GOUGH, COURTNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 E MISSISSIPPI AVE APT 18-101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3185
Mailing Address - Country:US
Mailing Address - Phone:559-840-5027
Mailing Address - Fax:
Practice Address - Street 1:630 PLAZA DR STE 101
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2379
Practice Address - Country:US
Practice Address - Phone:720-577-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009923310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker