Provider Demographics
NPI:1750627329
Name:GOOCH, ALAN S (LCSW)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:GOOCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-263-2377
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:SUITE #3
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-263-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical