Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0065 | KY |
Y | 103TC0700X | Clinical Psychologist | 0065 | KY |
NPI | 1003965054 |
---|---|
Provider Name | Mr. John H Gould |
First Address | Lexington, KY 40511-1217 |
Second Address | Danville, KY 40422-1235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 27/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30615058 | (05) | KY |