Basic Information
| Provider Information | |||||||||
| NPI: | 1811264724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDOUGAL | ||||||||
| FirstName: | GIFT | ||||||||
| MiddleName: | WAHIWE | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11059 E BETHANY DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036272009 | ||||||||
| FaxNumber: | 3036172397 | ||||||||
| Practice Location | |||||||||
| Address1: | 11059 E BETHANY DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036272009 | ||||||||
| FaxNumber: | 3036172397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2011 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | 0004288 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.