Individual
BRYAN GOUGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
107 CHESLEY DR, UNIT 5, MEDIA, PA 19063-1760
(610) 644-6464
(610) 566-1669
Mailing address
1440 RUSSELL RD, PAOLI, PA 19301-1236
(610) 644-6464
(610) 644-4066
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/12/2010
Last updated
04/12/2010
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