Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2018030706 | MO |
NPI | 1033519350 |
---|---|
Provider Name | Lauren A Golden |
First Address | Springfield, MO 65806-2225 |
Second Address | Springfield, MO 65802-6287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 21/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
490049877 | (05) | MO |