Provider Demographics
NPI:1598884280
Name:MCGOUGH, STEVEN L (LMFT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HERRADA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8791
Mailing Address - Country:US
Mailing Address - Phone:505-466-2198
Mailing Address - Fax:
Practice Address - Street 1:3 HERRADA CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8791
Practice Address - Country:US
Practice Address - Phone:505-466-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM000221Medicaid