Provider Demographics
NPI:1295098820
Name:GOUGH, NIKITA RANAE (MA)
Entity type:Individual
Prefix:MRS
First Name:NIKITA
Middle Name:RANAE
Last Name:GOUGH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:NIKITA
Other - Middle Name:RANAE
Other - Last Name:SNEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:12005 E 470 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3737
Mailing Address - Country:US
Mailing Address - Phone:918-342-0770
Mailing Address - Fax:918-342-0087
Practice Address - Street 1:12005 E 470 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3737
Practice Address - Country:US
Practice Address - Phone:918-342-0770
Practice Address - Fax:918-342-0087
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK5647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor