Provider Demographics
NPI:1144941600
Name:TOURE, GAOUSSOU
Entity type:Individual
Prefix:
First Name:GAOUSSOU
Middle Name:
Last Name:TOURE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14304 HOLLYHOCK WAY
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1700
Mailing Address - Country:US
Mailing Address - Phone:202-674-0006
Mailing Address - Fax:
Practice Address - Street 1:816 THAYER AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4508
Practice Address - Country:US
Practice Address - Phone:301-755-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician