Provider Demographics
NPI:1588662621
Name:GOULD, JOHN ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:GOULD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10217 BROOMFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1447
Mailing Address - Country:US
Mailing Address - Phone:512-576-5052
Mailing Address - Fax:512-301-0196
Practice Address - Street 1:1801 N LAMAR BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1051
Practice Address - Country:US
Practice Address - Phone:512-499-8674
Practice Address - Fax:512-499-0846
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T92YMedicare ID - Type UnspecifiedPROVIDER NUMBER