Individual
IAN BRODERICK GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
1616 N DAMEN AVE UNIT 301, CHICAGO, IL 60647-5536
(888) 303-2844
Mailing address
1616 N DAMEN AVE UNIT 301, CHICAGO, IL 60647-5536
(888) 303-2844
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
178018226
IL
Other
Enumeration date
09/28/2021
Last updated
04/24/2023
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