Provider Demographics
NPI:1790012029
Name:GOUGH, JORDAN MICHELLE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:MICHELLE
Last Name:GOUGH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1777 S HARRISON ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3955
Mailing Address - Country:US
Mailing Address - Phone:303-558-6592
Mailing Address - Fax:720-637-6635
Practice Address - Street 1:1777 S HARRISON ST STE 1200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3955
Practice Address - Country:US
Practice Address - Phone:303-558-6592
Practice Address - Fax:720-637-6635
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999061-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty