Tim Duane Gough Jr., LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28745 Issued in MD

Practice address

102 E Cecil Ave Ste B
North East, MD 21901-4057

Phone

(667) 231-1269

NPI assigned

Jul 11, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thriving Minds Therapy, LLC

  • Clinical Social Worker
  • North East, MD
  • NPI 1679370159
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766102400000",
    "number": "1457085037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E CECIL AVE STE B",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219014057",
            "telephone_number": "667-231-1269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E CECIL AVE STE B",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219014057",
            "telephone_number": "667-231-1269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "TIM",
        "middle_name": "DUANE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-11",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "28745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alfred Michael Gathura
• Karen Brown Giffing, PT
• Alexandra Robinson Gilbert
• Ann Gonzalez, LMSW
• Christine Gonzalez
• Kelly Ann Marie Grande, LCSW-C
• Angela Marie Gray
• Joseph Anthony Gwiazdowski, DDS
• Aaron James Haley, DDS
• Paul Nicholas Henry

• Clinical Social Worker in North East, MD
• Providers in North East, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.