Provider Demographics
NPI:1922241256
Name:GOULD, ANGELA PUPO (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:PUPO
Last Name:GOULD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1634 WALNUT ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5400
Mailing Address - Country:US
Mailing Address - Phone:720-304-7180
Mailing Address - Fax:720-304-8108
Practice Address - Street 1:1634 WALNUT ST
Practice Address - Street 2:SUITE 221
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5400
Practice Address - Country:US
Practice Address - Phone:720-304-7180
Practice Address - Fax:720-304-8108
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84326Medicare PIN