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1295341428
JERRY DWYANE SHOUGH
ANCHORAGE, AK
NPI
1295341428
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2020-09-22
Last Update Date
2020-09-22
Business Address
JERRY DWYANE SHOUGH
1709 BRAGAW ST
ANCHORAGE, AK 99508-3436
Phone number: 907-562-5340
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Mailing Address
JERRY DWYANE SHOUGH
2720 DERBY WAY
ANCHORAGE, AK 99504-3231
Phone number: 907-223-2665
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