Provider Demographics
NPI:1154928976
Name:GOUGE, ANA-ALICIA
Entity type:Individual
Prefix:
First Name:ANA-ALICIA
Middle Name:
Last Name:GOUGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:LA
Mailing Address - Zip Code:71354-4606
Mailing Address - Country:US
Mailing Address - Phone:504-451-2734
Mailing Address - Fax:
Practice Address - Street 1:1105 HUDSON LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6003
Practice Address - Country:US
Practice Address - Phone:318-322-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health