Provider Demographics
NPI:1750554374
Name:GOUGH, SHARON ROSE (LPCC LADAC PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ROSE
Last Name:GOUGH
Suffix:
Gender:F
Credentials:LPCC LADAC PHD
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 MORGAN ST STE D
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-3078
Practice Address - Country:US
Practice Address - Phone:254-724-2585
Practice Address - Fax:254-953-7603
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10681101YA0400X
TX63100101YP2500X, 101YP2500X
NM0076991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)