Individual
MRS. MARILYN L GOUGUET SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
703 W CANAL ST, PICAYUNE, MS 39466-3918
(601) 749-9477
(601) 889-1265
Mailing address
703 W CANAL ST, PICAYUNE, MS 39466-3918
(601) 749-9477
(601) 889-1265
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C2203
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124987
—
MS
Enumeration date
07/30/2006
Last updated
07/08/2007
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