Individual
MARISSA JORDYN GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 SEQUOYAH LN, ALTUS, OK 73521-1756
(580) 379-0203
Mailing address
111 SEQUOYAH LN, ALTUS, OK 73521-1756
(580) 379-0203
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11721
OK
Other
Enumeration date
02/22/2021
Last updated
04/16/2025
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