Provider Demographics
NPI:1801252861
Name:ALAN GOOCH, LCSW, PLLC
Entity type:Organization
Organization Name:ALAN GOOCH, LCSW, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:606-782-1895
Mailing Address - Street 1:225 WALTON AVE
Mailing Address - Street 2:STE 124
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1441
Mailing Address - Country:US
Mailing Address - Phone:859-402-2362
Mailing Address - Fax:859-685-8345
Practice Address - Street 1:225 WALTON AVE
Practice Address - Street 2:STE 124
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1441
Practice Address - Country:US
Practice Address - Phone:859-402-2362
Practice Address - Fax:859-685-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3719251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health