Provider Demographics
NPI:1417188582
Name:GOULD, ROBERT L JR (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:GOULD
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 AUTUMN CHASE LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7773
Mailing Address - Country:US
Mailing Address - Phone:573-631-2525
Mailing Address - Fax:
Practice Address - Street 1:322 AUTUMN CHASE LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-7773
Practice Address - Country:US
Practice Address - Phone:573-631-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035065101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional