Doctor Name: | MS. KELLY MARIE GAUGHAN |
NPI Number: | 1265496632 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BS |
License Number: | |
Business Practice Address: | 102 Warren St Tunkhannock, PA - 18657 |
Business Phone Number: | 5708361101 |
Business Fax Number: | 5708363765 |
Mailing Address: | 33 East Northampton Street, WILKES BARRE |
State: | PA |
Postal Code: | 187012492 |
Phone Number: | 5708227118 |
Fax Number: | 5708297781 |
NPI Enumeration Date: | 04/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |