Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003013327 |
---|---|
Provider Name | Deanna Gold |
First Address | Portland, OR 97232-2869 |
Second Address | Portland, OR 97232-2684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 10/07/2011 |