Individual
AMANDA A GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MLSW
Contact information
Practice address
3298 VETERANS DR, TRAVERSE CITY, MI 49684-4725
(231) 715-8466
(231) 943-2263
Mailing address
3298 VETERANS DR, TRAVERSE CITY, MI 49684-4725
(231) 715-8466
(231) 943-2263
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801105682
MI
1041C0700X
Clinical Social Worker
Primary
6801105682
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174172159
—
MI
Enumeration date
09/11/2019
Last updated
02/16/2026
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