Healthcare Provider Details

I. General information

NPI: 1255336111
Provider Name (Legal Business Name): JO ANNE GOLDEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 SLATER AVE STE 237
FOUNTAIN VALLEY CA
92708-4723
US

IV. Provider business mailing address

10101 SLATER AVE STE 237
FOUNTAIN VALLEY CA
92708-4723
US

V. Phone/Fax

Practice location:
  • Phone: 714-968-4202
  • Fax: 714-968-4302
Mailing address:
  • Phone: 714-968-4202
  • Fax: 714-968-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: