Provider Demographics
NPI:1740345461
Name:MCGOUGH, ALLAN (MSW-LCSW-QMHP)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:MSW-LCSW-QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:LEMMON
Mailing Address - State:SD
Mailing Address - Zip Code:57638-0447
Mailing Address - Country:US
Mailing Address - Phone:605-374-3862
Mailing Address - Fax:605-374-3864
Practice Address - Street 1:11 4TH ST E
Practice Address - Street 2:
Practice Address - City:LEMMON
Practice Address - State:SD
Practice Address - Zip Code:57638-1524
Practice Address - Country:US
Practice Address - Phone:605-374-3862
Practice Address - Fax:605-374-3864
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4996764OtherBCBS PROVIDER #