Provider Demographics
NPI:1902815210
Name:GOUGH-ATKINS, ROBERTA (MS,LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:GOUGH-ATKINS
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:G
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,LPC
Mailing Address - Street 1:6000 S STAPLES ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2952
Mailing Address - Country:US
Mailing Address - Phone:361-985-1541
Mailing Address - Fax:361-985-2065
Practice Address - Street 1:6000 S STAPLES ST
Practice Address - Street 2:SUITE 403
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2952
Practice Address - Country:US
Practice Address - Phone:361-985-1541
Practice Address - Fax:361-985-2065
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional