Provider Demographics
NPI:1629309455
Name:MCGOUGH, JIM HEATH
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:HEATH
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6822
Mailing Address - Country:US
Mailing Address - Phone:405-444-0585
Mailing Address - Fax:
Practice Address - Street 1:1514 IOWA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6822
Practice Address - Country:US
Practice Address - Phone:405-444-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional