Provider Demographics
NPI:1184493793
Name:GAUGER, MATT RAY (LPC)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:RAY
Last Name:GAUGER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-2311
Mailing Address - Country:US
Mailing Address - Phone:605-886-5262
Mailing Address - Fax:605-886-5228
Practice Address - Street 1:120 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-2311
Practice Address - Country:US
Practice Address - Phone:605-886-5262
Practice Address - Fax:605-886-5228
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1729303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional