Provider Demographics
NPI:1720791809
Name:JOANNA GOULD COUNSELING
Entity Type:Organization
Organization Name:JOANNA GOULD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:DANUTA
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-683-7994
Mailing Address - Street 1:188 SHOPPING PLAZA RD # 214
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5205
Mailing Address - Country:US
Mailing Address - Phone:802-230-7747
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1000A
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7812
Practice Address - Country:US
Practice Address - Phone:802-230-7747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1031452Medicaid