| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JORDAN MICHELLE GOUGH | 1790012029 | 2024-04-06 |
Jordan Michelle Gough is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1790012029. Registration indicates Jordan Michelle Gough is a provider of access to mental health/behavioral health providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Psych/Mental Health, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Psych/Mental Health, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Entity Type | Individual |
| Provider Name | Mrs. Jordan Michelle Gough PMHNP-BC |
| Practice Office Address | 1777 S HARRISON ST STE 1200 DENVER, CO US |
| Practice Office Telephone | 3035586592 |
| Practice Office Fax | 7206376635 |
| Mailing Address | 1777 S HARRISON ST STE 1200 DENVER, CO 802103955 US |
| Business Telephone | 3035586592 |
| Business Fax | 7206376635 |
| Code | Practice | License No State |
|---|---|---|
| 363LP0808X PRIMARY | Access to Mental Health/Behavioral Health Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Psych/Mental Health All Other Specialties & Provider Types Nurse Practitioner Psych/Mental Health Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | APN.0999061-NP
CO |
| 193400000X SING | Group Code |