1295788867 NPI number — TIMOTHY D. GOULD ED.D LPC

Table of content: ABDULLATIF NURIE (NPI 1023800760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295788867 NPI number — TIMOTHY D. GOULD ED.D LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOULD
Provider First Name:
TIMOTHY
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ED.D LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295788867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 S KINGSHIGHWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIKESTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63801-4415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-979-3676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 S KINGSHIGHWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIKESTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63801-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-979-3676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  002646 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: CS002646 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 431823864 . This is a "MISSOURI ALLIANCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 11-3764474 . This is a "MAGELLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 420291 . This is a "HEALTHLINK/FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 493840714 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49906211 . This is a "EPOCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 420291 . This is a "FORTIS/HL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431823864 . This is a "CORPHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 156007 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431823864 . This is a "GREATWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311575142 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 420291 . This is a "HEALTHLINK PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100387 . This is a "VETERANS ADMINISTRATION" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431823864 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431823864 . This is a "WELLPOINT" identifier . This identifiers is of the category "OTHER".




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