Provider Demographics
NPI:1396160941
Name:GOULD, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:GOULD
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 1:405 E CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-2903
Mailing Address - Country:US
Mailing Address - Phone:870-291-2517
Mailing Address - Fax:
Practice Address - Street 1:70 BATESVILLE BLVD STE C
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-8972
Practice Address - Country:US
Practice Address - Phone:870-793-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator