Provider Demographics
NPI:1750004974
Name:GOUGH, DEBBIE DIANE (APCC & MHCA)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:DIANE
Last Name:GOUGH
Suffix:
Gender:F
Credentials:APCC & MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8594 SANTA ROSA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4947
Mailing Address - Country:US
Mailing Address - Phone:805-835-1797
Mailing Address - Fax:
Practice Address - Street 1:830 SE IRELAND ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5502
Practice Address - Country:US
Practice Address - Phone:360-679-7676
Practice Address - Fax:360-679-9239
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC11298101YM0800X
WAMC61311711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health