Provider Demographics
NPI:1215791553
Name:GOUGH-FLEMING, FAITH IVY
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:IVY
Last Name:GOUGH-FLEMING
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 1:814 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3517
Mailing Address - Country:US
Mailing Address - Phone:530-207-0655
Mailing Address - Fax:
Practice Address - Street 1:814 COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3517
Practice Address - Country:US
Practice Address - Phone:530-207-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health