Provider Demographics
NPI:1194439604
Name:GOURLEY, MARGUERITE BREANNE (LMSW)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:BREANNE
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARGUERITE
Other - Middle Name:BREANNE
Other - Last Name:HIGBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1010 E MINNEZONA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3921
Mailing Address - Country:US
Mailing Address - Phone:928-814-2774
Mailing Address - Fax:
Practice Address - Street 1:7420 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3509
Practice Address - Country:US
Practice Address - Phone:480-300-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical