Provider Demographics
NPI:1790256634
Name:MCGOUGH, KIMBERLY JEAN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JEAN
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 NAVAJO ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3421
Mailing Address - Country:US
Mailing Address - Phone:832-499-2470
Mailing Address - Fax:
Practice Address - Street 1:6021 FAIRMONT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4511
Practice Address - Country:US
Practice Address - Phone:832-499-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional