Provider Demographics
NPI:1336364884
Name:MCGOUGH, DAVID PAUL (EDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E PUSCH WILDERNESS DR
Mailing Address - Street 2:4201
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-6001
Mailing Address - Country:US
Mailing Address - Phone:231-286-7997
Mailing Address - Fax:
Practice Address - Street 1:3645 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3320
Practice Address - Country:US
Practice Address - Phone:520-232-8400
Practice Address - Fax:520-232-8678
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool