Provider Demographics
NPI:1790802205
Name:GOUCHER, VIRGINIA E
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:E
Last Name:GOUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-9706
Mailing Address - Country:US
Mailing Address - Phone:580-323-2681
Mailing Address - Fax:
Practice Address - Street 1:90 NORTH THIRTY-FIRST STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:580-323-0820
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator