1801252861 NPI number — ALAN GOOCH, LCSW, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801252861 NPI number — ALAN GOOCH, LCSW, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAN GOOCH, LCSW, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1801252861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 WALTON AVE
Provider Second Line Business Mailing Address:
STE 124
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40502-1441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-402-2362
Provider Business Mailing Address Fax Number:
859-685-8345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 WALTON AVE
Provider Second Line Business Practice Location Address:
STE 124
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40502-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-402-2362
Provider Business Practice Location Address Fax Number:
859-685-8345
Provider Enumeration Date:
01/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GOOCH
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/PSYCHOTHERAPIST
Authorized Official Telephone Number:
606-782-1895

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  3719 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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