Individual
BETH MCGOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 BARR ST, FORT WAYNE, IN 46802-3502
(260) 467-1078
(260) 467-1188
Mailing address
1200 BARR ST, FORT WAYNE, IN 46802-3502
(260) 467-1078
(260) 467-1188
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1452767
IN
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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