Basic Information
| Provider Information | |||||||||
| NPI: | 1750554374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOUGH | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | LPCC LADAC PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844658 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844658 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 MORGAN ST STE D | ||||||||
| Address2: | |||||||||
| City: | HARKER HEIGHTS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765483078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547242585 | ||||||||
| FaxNumber: | 2549537603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2008 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 10681 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 63100 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.